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Hoxton Hall Summer Holiday Program 2022
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 the Data Protection Act 1998 and subsequent updates and amendments.
Please fill out one form per participant.
We will be running Monday 25th July 2022 - Thursday 25th August 2022 10:30am - 3:30pm
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Participants First Name
*
Your answer
Participants Surname
*
Your answer
Participants Age
*
Your answer
Participants Gender
*
Female
Male
Other:
Date Of Birth
*
MM
/
DD
/
YYYY
Week One Musial Theatre 7-10
Yes
Week One Music Production 11-19
Yes
Week Two Dance 7-10
Yes
Week Two Dance 11-19
Yes
Week Three African Drumming & Dance 7-10
Yes
Week Three African Drumming & Dance 11-19
Yes
Week Four Girls Group Singing 10 - 17 (GIRLS ONLY)
Yes
Week Four Music Production 11-19
Yes
Week Five Carnival 7-10
Yes
Week Five Carnival 11-19
Yes
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Parent/Career Name
*
Your answer
Parent/Career Contact Number
*
Your answer
Young Person Contact Number
Your answer
Email Address
*
Your answer
Postal Address Line 1
Your answer
Postal Address Line 2
Your answer
Borough
Your answer
Postcode
*
Your answer
Ethnicity
Your answer
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.)
*
Your answer
I consent to the participant receiving emergency medical first aid if necessary
*
Yes
No
Are they allowed to go home by themselves?
*
Yes
No
I give permission for my child to go outside to various locations such as parks as part of this project
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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
*
No
Yes
Does your child receive free school meals
*
Yes
No
Are you happy for us to share your details with similar organisations
Yes
No
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