Young Identity Consent Form
The below personal information will only be used to contact you/ your emergency contact about the project you are participating in. Other personal information you provide will be kept confidential and will only be used for ensuring your welfare and requirements are met during the project.

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Name of project / event you are attending *
Name *
Pronoun (optional)
Gender (optional)
Date of Birth *
MM
/
DD
/
YYYY
Address *
Postcode *
Contact telephone number
Contact email
Do you have any conditions requiring medical treatment or medication? Yes/No *
If yes, please specify
Do you have any dietary requirements / food allergies? *
If yes, please provide details below.
Do you have any specific educational needs? Yes/No. If Yes, please specify any information we should be aware of: *
Please provide a name and number for an Emergency Contact *
If you would like to receive information on future HOME projects, please provide a valid email address to send information to
Would you like to be added to our mailing list?
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Have you attended our theatre productions as part of our £1 Inspire Ticket Scheme for local community groups
Clear selection
Do you consider yourself to have a disability?
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Please indicate your ethnic background
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7. As part of this project we will be taking/recording photos/audio/video/film footage of the people that participate. These images/ recordings may be used for exhibition and publicity or for documentation and evaluation purposes. This is particularly important and they are a valuable resource to help us understand the work we do. We are therefore asking your permission to use any photos/audio/video/film footage taken for this purpose. The material will be used in a way, which reasonably promotes the aims of the project. The copyright of any material that has been generated as a result of this video footage shall be assigned to HOME trading under GMAC.I hereby grant¬ HOME trading under GMAC the right to use the photos/audio/video/film footage and any reproductions or adaptations of the photos/audio/video/film footage for all general purposes in relation to the organisations work, including the right to use them in any publicity materials, books, newspapers, funding reports and case studies, magazine articles and on HOME’s internet websites, apps, social networking sites and on their YouTube channels; for this activity and for the year of 2021 / 2022.  If you agree with the above statement please sign and date below i.e. J.Bloggs 01.01.2001
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