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Computer Class
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Name
*
Your answer
Date of Birth
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MM
/
DD
/
YYYY
Gender
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Male
Female
Other
Home Address
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Your answer
Telephone & or Email
*
Your answer
Ethnicity
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Arab
Asian or Asian British : Indian
Asian or Asian British: Pakistan
Asian or Asian British: Bangladeshi
Asian or Asian British: Chinese
Asian or Asian British: Other
Black or Black British: African
Black or Black British: Caribbean
Black or Black British: Other
Hispanic or Latinx
Mixed: White and Black Caribbean
Mixed: White and Black African
Mixed: White and Asian
Mixed: White and Hispanic/Latinx
Mixed: Other
White: British
White: Irish
White: Gypsy or Irish Traveller
White: Other
Other Ethnic Group
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Other:
What level of computing would you describe yourself at?
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Beginner
Mid range
Advanced
What is your profession
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Your answer
What is your religion or belief?
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Agnostic
Atheist
Buddhist
Christian
Hindu
Humanist
Jewish
Muslim
Sikh
Spiritualist
Other
Prefer to self-describe
Do you consider yourself to have a disability?
*
Yes
No
Prefer not to say
Why are you seeking computer classes?
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Your answer
I understand that during activities, photos and videos will be taken of me. I consent to these being used in media distribution relating to the Saturday Club and Leeanna’s Wish CIC
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No
Signature (digital ok)
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Your answer
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