The Writers' Room 2020 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 with our funder's Hackney Council. Hackney Empire 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. The Writers' Room is for ages 14-21. If you have any questions regarding the sign up process, please contact projects@hackneyempire.co.uk. Due to Covid19, social distancing measures will be in place at Hackney Empire.

I am within the age range

I am outside of the age range - please email us to discuss

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* 2. 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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* 3. 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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* 4. Gender

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* 5. Education (where applicable)

Name of School/College

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* 6. Which Writing workshops would you like to attend?

Monday 26th October, 1pm-5pm: Creative Writing part 1 with Jasmyn Fisher-Ryner (Writer & Producer, Royal Court Theatre & Hackney Empire)

Tuesday 27th October, 1pm-5pm: Song writing for vocalists with Hamzaa (Recording artist)

Wednesday 28th October, 1pm-5pm: Creative Writing part 2

Thursday 29th October, 1pm-5pm : Song writing for rappers/MC’s with Jammz (Grime MC, producer and writer)

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* 7. Why would you like to take part in the writing sessions?

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* 8.
Parent/ Carer/ Emergency Contact Details

Full Name

Relationship to applicant

Email Address

Phone Number

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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. PERSONAL/PARENT/GUARDIAN CONSENT: Workshops are for young people aged 14-21 y/o. Please confirm the participant registering is within this age range.
UNDER 18'S-To take part we will require consent from your parent/guardian. By ticking this box you agree that you have consent and are happy for us to email your emergency contact to confirm this consent. If you have any questions please email projects@hackneyempire.co.uk

Yes

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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?

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. The Writers' Room is for ages 14-21. If you have any questions regarding the sign up process, please contact projects@hackneyempire.co.uk. Due to Covid19, social distancing measures will be in place at Hackney Empire.

Question Title

* 2. Personal Details

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* 3. 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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* 4. Gender

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* 5. Education (where applicable)

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* 6. Which Writing workshops would you like to attend?

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* 7. Why would you like to take part in the writing sessions?

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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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* 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?

* 8.
Parent/ Carer/ Emergency Contact Details