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Re-Imagine registration form
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Name of young person
Your answer
Age of young person
Your answer
Young persons gender
Female
Male
Other
Prefer not to say
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Parent/Guardian name
Your answer
Parent/Guardian primary email address
Your answer
Does your young person have any allergies or medical conditions that you would like us to know about?
Your answer
Does your young person have any access issues you would like us to be aware of?
Your answer
e-mail address to send Zoom link for workshops
Your answer
I give consent for my young person’s personal data, as provided, to be processed in line with the purposes detailed in the Privacy Statement at the end of this form.
Yes
No
Clear selection
I give consent for photograph/video footage of my young person to be taken during the workshop.
Yes
No
Clear selection
I give consent for photographs/video footage including my young person to be used publicly in posters/flyers and/or newspapers for publicity purposes.
Yes
No
Clear selection
How did you hear about us?
Radio
Facebook
Instagram
Twitter
Word of mouth
Poster
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