Beatboxing at Soundwave

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Thanks for your interest in Beatboxing at Soundwave in Mitcham. This is a course of 10 sessions beginning on Tuesday 29th February 4.15 to 5.00pm. The sessions are funded by The Jack Lonergan Foundation and places are prioritised to those young people eligible for Pupil Premium or Free School Meals. We will notify you by email if we are able to offer you a place. We expect to repeat this course in the Summer Term and we will keep your details on file if you are not successful in the first round of applications.

Find out more about The Jack Lonergan Foundation here. www.thejacklonerganfoundation.org

The Jack Lonergan Foundation (TJLF) requires some of your personal data in order to process this application. All data provided is handled and stored by TJLF in compliance with the Data Protection Act 2018.

Our full Data Protection Policy, Privacy Policy and Terms and Conditions can be found on our website: www.thejacklonerganfoundation.org

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About The Student

First Name *

Surname *

Address First Line *

Address Second Line (Optional)

School *

Name of school if not listed

Year Group *

Emergency Contact Number *

Pupil Premium
Does this student qualify for Pupil Premium funding at school?
*

Yes

Required

Free School Meals

Please tick this box if this student is entitled to Free School Meals at school (Other than the 2023/24 Free School Meals in London Scheme)

English As An Additional Language

Please tick this box if the student’s first language isn’t English.

Looked After Child

Select this box if this is a Looked After Child (Foster Care/Residential Home/Relatives)

Special Educational Need
Is this student registered at school as having Special Educational Needs and/or Disabilities (SEND)?
*

Yes

Required

Additional Needs

Please tell us about any additional needs that this student has. We want to know about anything that may support or hinder their learning experience with us, so that we can best support them. You might choose to tell us about strategies that support their learning, instances of neurodivergence, details about their SEND status, details of an EHCP if they have one, confirmed or suspected diagnoses, or any other information that you feel may be relevant.

Date Of Birth *

YYYY

Gender *

Does the student identify as the same sex they were assigned at birth?

We ask this for Equal Opportunities monitoring purposes in order to report accurately to our funders and partners. All data is anonymised before reporting. Any data that you provide will be kept securely and will not be shared with the student's school or tutor.

Preferred Pronouns
Pronouns can be used to refer to a person in place of their name (e.g. ‘she is over there’). Please tell us which pronouns the student prefers to be referred to by.

Space to specify Preferred Pronouns if not listed

Ethnicity
Which of the following options best describes the student's ethnicity?
*

Space to specify ethnicity

Medical Information
Please tell us about any medical information that may be relevant. If the student has a severe or life-threatening condition, please contact us to discuss further.

Allergies & Intolerances

Please list any allergies or intolerances that we should be aware of. If the student has any life-threatening allergies, please contact us to discuss further.

Photo Consent
Photographs and/or video recordings may be taken of your child whilst participating in Jack Lonergan Foundation activities. We are seeking your permission to use such images/recordings for promotional purposes, including the Jack Lonergan Foundation website and social media pages. Images and videos may also be shared with associated partners, funders and media outlets, where appropriate. Do you grant photo consent for this student?
*

Yes

Required

E-Learning Consent
We sometimes teach lessons online (e.g. in the event of disruption due to COVID). We require consent for lessons to take place online via Zoom in line with our Online Learning Code of Conduct.
*

Yes

Required

Media call list opt-in

Please check this box if you would like to be contacted as and when the need arises for student volunteers to participate in creating promotional materials (e.g. videos, photographs, voiceovers, quotes etc). 1

About the Parent/Guardian

First Name *

Surname *

What is your relationship to this child? *

Address First Line *

Address Second Line (Optional)

Postcode *

Mobile Phone *

Phone - Home (optional)

Phone - Work (optional)

Email *

Repeat Email *

How did you hear about us? *

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