The Writers' Room 2020 Registration Form for November-December

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, the programme will be run online with the potential to continue at Hackney Empire if legalisation changes.

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. This programme is for a selected group who will write a script over 6 weeks. We will work with you to create a short script for theatre, screen of performance poetry - please tell us a bit about your idea for your script, if you would like to share an example of your writing please include or email to projects@hackneyempire.co.uk with your name so we can link it to your registration

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* 7.
Guardian/Parent/ Carer for Emergency Contact Details- we require two contacts- please list your guardian/primary contact first, followed by a secondary contact this could be a relative or trusted adult

Primary Contact-Full Name *

Relationship to applicant *

Email Address

Phone Number

Secondary Contact-Full Name

Relationship to applicant

Email Address *

Phone Number *

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

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* 9. 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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* 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

Question Title

* 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, the programme will be run online with the potential to continue at Hackney Empire if legalisation changes.

Question Title

* 2. Personal Details

Question Title

* 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.

Question Title

* 4. Gender

Question Title

* 5. Education (where applicable)

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* 7. Guardian/Parent/ Carer for Emergency Contact Details- we require two contacts- please list your guardian/primary contact first, followed by a secondary contact this could be a relative or trusted adult

Question Title

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

Question Title

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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.
Guardian/Parent/ Carer for Emergency Contact Details- we require two contacts- please list your guardian/primary contact first, followed by a secondary contact this could be a relative or trusted adult