HE Creative Futures Registration Form for SHIFTING FOCUS 22nd - 24th October

Shifting Focus

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

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* 3. Gender

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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

Film making

Director

Photography

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* 6. 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. This project is aimed at ages 16-21. Please tick if this applies to you

Yes

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* 10. You need to be able to attend all the dates of the project: Monday 22nd October 10am-4pm, Tuesday 23rd October 10am-4pm and Wednesday 24th October 10am-4pm. Please confirm you are available by ticking the box below

I confirm I am available for all the dates

Other (please specify)

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

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

Question Title

* 3. Gender

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* 4. Education (where applicable)

Question Title

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

Question Title

* 6. Why would you like to take part in this activity?

Question Title

* 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?

Question Title

* 9. This project is aimed at ages 16-21. Please tick if this applies to you

Question Title

* 10. You need to be able to attend all the dates of the project: Monday 22nd October 10am-4pm, Tuesday 23rd October 10am-4pm and Wednesday 24th October 10am-4pm. Please confirm you are available by ticking the box below

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* 12. How did you find out about us?

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

* 7.
Parent/ Carer/ Emergency Contact Details