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Spring Term registration form
Welcome to the Hoxton Hall Youth Arts Department.
Spring term starts Monday the 10th of January - until April the 1st (half term Feb the 14th)
Please fill in one form per participant
By filling out this form you give permission for the London Borough of Hackney Youth Service to store the data for monitoring and funding purposes. I understand the data will be held in line with the Data Protection Act 1998 and subsequent updates and amendments.
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Participants First Name
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Your answer
Participants Sir Name
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Your answer
Age
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Gender
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Your answer
ages 7-10 Monday Dance 4pm-5pm
Option
Clear selection
ages 11-14 Monday Dance 5pm -6pm
Option
Clear selection
ages 15-19 Monday Dance 6pm-7pm
Option
Clear selection
11-16 Tuesday Young Women's group 4:30-6pm
Option
Clear selection
7-14 Wednesday Art class 4pm- 5pm
Option
Clear selection
12-16 Wednesday Young Leaders 5pm-6:30pm
Option
Clear selection
7-10 Thursday Drama 4pm-5pm
Option
Clear selection
11-16 Thursday Drama 5-6:30pm
Option
Clear selection
14-19 Saturday Music Production 11am -1pm
Option
Clear selection
14-19 Digital Music Saturday 2pm-4pm
Option
Clear selection
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)
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Your answer
Please give details of any special educational needs that it would be useful for us to be aware of
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Your answer
Parent/Carer name
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Your answer
Parent/Carer contact number
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Your answer
Young person direct telephone contact (over 14)
Your answer
Parent/Carer email address
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Your answer
Postal address line one
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Your answer
Postal address line two
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Your answer
Parent/Carer contact number
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Your answer
Additional emergency contact number
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Your answer
Borough
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Your answer
Postcode
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Your answer
I consent to the participant receiving emergency medical procedures (we are required, through duty of care, to provide basic first aid, any more serious issues and you will be notified immediately)
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Yes
No
Other:
Are they allowed to go home by themselves?
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Yes
No
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
*
Yes
No
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