HE Creative Futures Registration Form for YOUNG PRODUCERS 2020

YOUNG PRODUCERS

Thank you for choosing to register with us. Hackney Empire will process your data in accordance with the General Data Protection Regulation (GDPR). Hackney Empire will use your information for administration, marketing and charitable purposes, and will not share your personal details with third parties without your consent. If you have any comments or concerns regarding the use of your data, please contact Hackney Empire.

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* 1. Personal Details

First Name *

Surname *

Date of Birth *

House Number/Name

Street Name *

City/Town

Postal Code *

Country *

Email Address *

Phone Number *

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* 2. We collect ethnicity and gender information to monitor equality and diversity. This information is given to our funders Hackney Council. Please select your ethnicity from the drop down list below or select prefer not say.

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* 3. Gender- please select the box you identify as or select prefer not to say

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* 4. Education (where applicable)

Name of School/College

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* 5. What are are you interested in? You can pick multiple boxes

Event Planning

Music

Marketing

Photography/Film

Producing

Journalism

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* 6. Young Producers will be held on Tuesdays from 6-8pm, starting on 07th Jan - 21 Feb. Why would you like to take part in this activity?

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* 7.
Parent/ Carer/ Emergency Contact Details

Full Name

Relationship to applicant

Email Address

Phone Number

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* 8. Do you have any medical conditions/disabilities/access requirements you would like us to know about?

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* 9. PARENTAL /GUARDIAN CONSENT FOR U-18s // PERSONAL CONSENT FOR 18+

I consent for the above participant to take part in the Creative Learning Programme at Hackney Empire.
I consent to the use of all audio and visual recordings of the above participant for the purpose of marketing and evaluation here at the Hackney Empire.

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* 10. How did you find out about us?

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* 11. Would you like to hear about future Creative Learning Opportunities at Hackney Empire?

Yes- I am happy to be contacted by Hackney Empire about further opportunities by email

Yes- I am happy to be contacted by Hackney Empire about further opportunities by phone

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* 1. Personal Details

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* 2. We collect ethnicity and gender information to monitor equality and diversity. This information is given to our funders Hackney Council. Please select your ethnicity from the drop down list below or select prefer not say.

Question Title

* 3. Gender- please select the box you identify as or select prefer not to say

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* 4. Education (where applicable)

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* 5. What are are you interested in? You can pick multiple boxes

Question Title

* 6. Young Producers will be held on Tuesdays from 6-8pm, starting on 07th Jan - 21 Feb. Why would you like to take part in this activity?

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* 7. Parent/ Carer/ Emergency Contact Details

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* 8. Do you have any medical conditions/disabilities/access requirements you would like us to know about?

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* 10. How did you find out about us?

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* 11. Would you like to hear about future Creative Learning Opportunities at Hackney Empire?

* 7.
Parent/ Carer/ Emergency Contact Details