Exhibit 2020 - North Herts Museum Residency
North Hertfordshire Museum residency sign up form.
Monday 7 - Friday 11 June 2021

Due to the ongoing COVID-19 pandemic, if social distancing measures are in place at time of event, some or all activity may have to take place online. Please be rest assured that BEEE Creative are prepared for all eventualities and the residency will still take place.  
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Email *
Name of Young Person: *
Young Person's Date of Birth: *
Young Person's Address: *
Young Person's Postcode: *
If you know, which administrative/political ward does your young person live in?
Your Name (Nominating Adult)- first name / last name : *
Your Relationship to the Young Person: *
Your contact telephone number: *
Your Email: *
Emergency Contact Details (if different from above - this should be a number we can contact you on throughout the time the Young Person is with us on the project): *
Brief reasons for nominating the Young Person to take part in the project: *
School the Young Person attends: *
Does the Young Person have any access requirements or needs that we should be aware of so that they can participate in the project (such as physical or learning disability, visual or hearing impairment, injury, behavioural or medical conditions, dietary requirements)? If yes, please provide details here: *
How did you find out about the Exhibit 2020 project? *
Personal Disclaimer:  All sessions are undertaken at the participant's own risk.  All participants must be in good health and physically fit before undertaking dance activities. If you are unsure, we recommend seeking professional medical advice before embarking on any physical activity or if you have any questions related to your health and physical fitness.  On behalf of the Young Person, do you agree to these terms and conditions? *
Do you give permission for us to administer first aid, including plasters? *
BEEE Creative CIO would like to send you information about future projects by email.  Do you want to hear about other BEEE Creative projects? *
BEEE Creative CIO would like to send you their latest information and updates on activities with a monthly newsletter distributed by Mailchimp.  Do you want to receive the monthly newsletter? *
Photographic and Video Consent:  We will photograph and film all Exhibit 2020 activities.  Photographs and/or film footage may be used for educational purposes such as evaluation and research reports both in print/ web and/ or project partners (Hertfordshire Museums, makeAMPLIFY, The National Lottery Heritage Fund) with BEEE Creative’s permission to promote BEEE Creative programmes on marketing materials, website and social media. No names will be placed next to photos or footage. Exhibit 2020 films will be used to create a publicly accessible installation, screened in public and online. As well as our own websites we have an online presence with Facebook, Twitter, Instagram, Vimeo and YouTube. The project partners also have an on-line presence and have been granted a licence by BEEE Creative CIO to use the resultant video for its own promotional purposes. As such, neither we nor the named partners can offer any warranty or set any restriction on the subsequent on-line use of the video. Do we have photo and film permission for your Young Person? *
Evaluation:  As part of the project, BEEE Creative will be evaluating the impact of the work on participants. All information obtained from observations, questionnaires and interviews will be kept strictly anonymous. Data will be stored in compliance with the European Union General Data Protection Regulation. The data will not be used for any other purpose than the evaluation project and will be destroyed on completion of the project and its outputs.  Do we have permission to use this information for our evaluation? *
Data Protection: BEEE Creative CIO and the project partners will use your data only in the pursuit of their business. It will not be used for any other purpose or shared with any other organisation or individual. Please sign below to confirm all the above information is correct and that you consent to the named Young Person participating in Exhibit 2020.
Date signed:
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A copy of your responses will be emailed to the address you provided.
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