Melting Pot Question Title * 1. Name: OK Question Title * 2. Date of birth: OK Question Title * 3. Email address: OK Question Title * 4. Contact number: OK Question Title * 5. Address: Name Address Address 2 City/Town ZIP/Postal Code Country OK Question Title * 6. Which of the following best describes your current occupation? Protective Service Occupations Installation, Maintenance, and Repair Occupations Building and Grounds Cleaning and Maintenance Occupations Production Occupations Personal Care and Service Occupations Office and Administrative Support Occupations Business and Financial Operations Occupations Computer and Mathematical Occupations Farming, Fishing, and Forestry Occupations Arts, Design, Entertainment, Sports, and Media Occupations Education, Training, and Library Occupations Architecture and Engineering Occupations Healthcare Support Occupations Legal Occupations Food Preparation and Serving Related Occupations Construction and Extraction Occupations Healthcare Practitioners and Technical Occupations Life, Physical, and Social Science Occupations Sales and Related Occupations Management Occupations Community and Social Service Occupations Transportation and Materials Moving Occupations Other (please specify) OK Question Title * 7. What do you hope to gain from the Melting Pot initiative? OK Question Title * 8. What qualities do you think you will bring to the group? OK Question Title * 9. The project runs from 6-9pm @ JW3 on the following days. Please indicate your availability for each: Available Unavailable Wednesday 17th October 2018 Wednesday 17th October 2018 Available Wednesday 17th October 2018 Unavailable Wednesday 14th November 2018 Wednesday 14th November 2018 Available Wednesday 14th November 2018 Unavailable Wednesday 28th November 2018 Wednesday 28th November 2018 Available Wednesday 28th November 2018 Unavailable OK Question Title * 10. Please tell us about any food allergies or dietary requirements that you have. (The meal will be fully Kosher) Vegetarian Vegan Nut allergy Dairy allergy Gluten allergy Other OK Question Title * 11. Photo Consent JW3 and sponsors would like to document this project for promotional purposes. These images may be sent out to the media with a press release, used for publications or on our website. Please let us know if you are happy for us to take your photos during the event and use these photos for publicity purposes. Yes I consent No I do not consent OK Question Title * 12. Photo Consent JW3 and sponsors would like to document this project for promotional purposes. These images may be sent out to the media with a press release, used for publications or on our website. Please let us know if you are happy for us to take your photos during the event and use these photos for publicity purposes. Yes I consent No I do not consent OK Question Title * 13. Photo Consent JW3 and sponsors would like to document this project for promotional purposes. These images may be sent out to the media with a press release, used for publications or on our website. Please let us know if you are happy for us to take your photos during the event and use these photos for publicity purposes. Yes I consent No I do not consent OK Question Title * 14. Data Protection JW3 will use the information disclosed in relation to this event only, in the instance we may need to contact you about your place on the project. For example, if you miss a session or have a specific dietary requirement we need clarification on. We will not share your information with any third party organisations or use your details for anything not related to this project. We would like to keep you informed about other activities for your age group at JW3. Please tick the relevant boxes you would like to receive information about: Mitzvah Day Volunteering Opportunities Leadership Opportunities Social events Friday Night Dinners New events None OK Question Title * 15. DeclarationI declare that I am aged 18 or over and that all information stated is true and correct at the time of completion. OK Thank you for taking the time to apply for this project. Applicants will be updated on their application progress in late September 2018. OK DONE