Term 5 Enrolment form

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Please provide complete and accurate information and inform us of any changes. Communication regarding course groups will usually be via email or text.

These sessions will be held at Old Chapel Studios, 1 Crossland Court, Czar Street, Holbeck, Leeds, LS11 9PR. Ableton Live (sound production will be held at the Cardigan Centre, 145-149 Cardigan Road, Burley, Leeds, LS6 1LJ

Your email is for Cloth Cat purposes only, it will not be used for any other purpose unless consent is given in one of the questions below.

Email *

Childs name *

Parent/Carer's name *

Childs date of birth (dd/mm/yy) *

Home address *

Postal code *

Gender *

Female

Male

Prefer not to say

Other:

Childs email (optional)

Childs mobile (optional)

Home phone number

Parent/Carer mobile number *

Mailing list consent

We would like to input your email into MailChimp (a company which complies with GDPR) in order to keep you updated with newsletters and relevant volunteering information? For further information about Mailchimp, please refer to this website address; www.mailchimp.com or to register yourself to receive the updates please visit http://eepurl.com/bQNXej to enter your details.

Mailing list consent *

Yes

Required

Childs School/College *

Childs Year Group in September

Yr 6

Yr 7

Yr 8

Yr 9

Yr 10

Yr 11

Yr 12

Other:

Clear selection

Emergency Contact details

the details given below are for emergency purposes only and will not be shared with any 3rd party outside of Cloth Cat.

Dr's name and address *

Dr's phone number *

Any medical or SEN information about your child (please state any allergies or medication)

Any other relevant information about child (i.e. plays an instrument, has singing lessons or requires additional support.

Our music sessions starting 13.09.2021 - 26.11.2021 (we will break for half term 25.10.21)

Monday - Ableton Live with Dan 5-6.30 at the Cardigan Centre (1 spaces)
Monday - 'Let Us Gig' form a band with Rob 5-6.30 (FULL)
Tuesday - Guitar with Jack 5.00-6.30 (1 space)
Wednesday - DJ with Mel 5.00 - 6.30 (2 spaces)
Thursday - Radio Cloth Cat (create a radio show) with Mick 5.00-6.30 (2 spaces)
Thursday - Singing/ song writing with Lisa 5.00-6.30 (3 spaces)
Friday - Keyboards with Matti 5.00-6.30 (1 space)
Friday - Drumming with Manni 5.00-6.30 (1 space)

If a session is now full email us at enquiries@clothcatleeds.org.uk to be placed on a waiting list as we do get cancellations

Sessions you wish to attend? *

Ableton (1 space)

DJing (2 space left)

Guitar (1 space)

Keyboard (1 space)

Radio Cloth Cat (2 spaces left)

Singing (3 spaces left)

Drums (1 space left)

Required

Does your child have the instrument required for the course and able to bring it with them? *

Yes

Safeguarding

We have a legal obligation to safeguard your child when they are in our care, please answer the following questions.

How will your child arrive to their session *

Car

Taxi

Bus

Walk

Will you be staying with your child in the designated waiting area? *

Yes

Maybe

Permissions

We may film some of our sessions for promotional use or evidence to our funder of the work we are doing. If we are filming for evidence purposes this will be passed to our funder and not shared with any other party.
We will also be live streaming the sessions so young people at home can watch if they are unable to attend. Please select options you are happy with below

Do you give consent for your child to be filmed? *

Yes (for all)

Yes (for funder evidance)

If you give permission to film your child for any use, please tick all categories for which you give consent *

Publicity leaflets or other printed publications

Promotional films

Authorised websites and social media including YouTube

News media and/or press releases

Live stream during lesson via Cloth Cat YouTube channel

Live stream during lesson via Open Source channels

None

Required

Parent Information

This information will only be shared with our funder for evidence, it will not have your personal information attached to it, it is for statistical purposes only.

Are you in receipt of any benefits? *

Yes

If yes please state which *

NONE

Carer's Allowance

Child Benefit

Child Tax credit

Disability Living Allowance

Free School meals

Housing Benefit

Incapacity Benefit

Income Support

Job Seekers Allowance

Personal Independance Payment (PIP)

Univeral Credit

Working Tax credit

Other:

Required

Do you give consent for your child to attend our course? *

Yes

Thank you

The form is now complete and a member of the Cloth Cat team will be in contact to confirm if your child has a place on one of our courses.

Data Protection Act 1998 & General Data Protection Regulation. By signing this form, you are consenting to Cloth Cat Studios using the information to process your application for membership of the Get Your Act Together Courses. Your information will not be disclosed outside of Cloth Cat Studios without your consent, except where we are required to do so by law. Cloth Cat Studios is required to submit anonymised data to The National Lottery and will ensure compliance, in line with Cloth Cat Studios obligations under the Data Protection Act 1998 and the General Data Protection Regulation.

Cloth Cat Studios Ltd, The Old Chapel, 1 Crossland Court, Czar Street, Leeds, LS11 9PR. Tel: 0113 2442773 enquiries@clothcatleeds.org.uk. Cloth Cat Studios Ltd is registered with the Financial Conduct Authority as an Industrial & Provident Society for the benefit of the community, registered in England No. 28890R and as a charity with the Inland Revenue ref. XR31169

A copy of your responses will be emailed to the address you provided.

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