Alter Ego 2019 Registration Form

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

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* 2. Education (where applicable)

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* 3. Your ethnic and gender information is required by our funders. Please select the appropriate box, thanks!

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* 4. Gender

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* 5. Area of interest 

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* 6. If you are auditioning as part of a group, please fill out the information below

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* 7. Alter Ego auditions will be held on Sat 6th April 2019. Please confirm that you will be available on this day

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* 8.

Parent/ Carer/ Emergency Contact Details

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

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* 10. 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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* 11. How did you find out about us?

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

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