Summer Term 2021
In order to ensure the safety of all of our participants this form must be completed fully by all parents/guardians. By filling out this form you give permission for the London Borough of Hackney Youth Service to collect and store personal data about me and the activities which I participate in for monitoring purposes. I understand the data will be held in line with  GDPR  2018 and subsequent updates and amendments.

Please fill out one form per participant.
Term dates

Monday 19th April 2021 - Thursday 27th May - First Half Term

May Half Term 2021 Monday 31st May - Friday 4th June 2021

Monday 7th June 2021 - Thursday 15th July 2021
Увійдіть в обліковий запис Google, щоб зберегти надані відповіді. Докладніше
Participant First Name *
Participant Surname *
Participant Age *
Participant Gender *
Date of Birth *
ДД
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ММ
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РРРР
Ethnicity
Dance 7-10 Monday 4pm - 5pm
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Dance Monday 5pm-6pm 11-14
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Dance Monday 6pm-7pm 15-19
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Tuesday Windrush Project 11-16 4:30pm - 5:30pm
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Art Wednesday 4pm-5pm 7-14
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Young Leaders Project 13-19 5pm-6:30 Wednesday
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Drama Thursday 7-10 4pm-5pm
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Drama Thursday 11-16 5pm-6pm
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Studio Session Saturday 14-19 11am-1pm
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Digital Music Saturday 14-19 2pm-4pm
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Please give details of any participant medical condition or allergies that it would be useful for us to be aware of (e.g. diabetes, epilepsy, asthma, hay fever etc.) *
Please give details of any special educational needs that it would be useful for us to be aware of *
Parent/Carer Name *
Parent/Guardian Contact Number *
Young Person Contact Number (if applicable)
Parent/Guardian Contact Email Address
Home Address Line 1 *
Home Address Line 2
Home Postcode *
 I consent to the participant receiving emergency medical or surgical procedures if necessary *
Are they allowed to go home by themselves? *
I consent to Hoxton Hall using images/video footage of the participant for promotional purposes, including flyers, posters, reports, press, media and on its own website *
Are you happy for us to share information with similar organisations *
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