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Hoxton Hall Summer Holiday Program 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 your child and the activities which they participate in for monitoring purposes. You hereby 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.
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Participants First Name
*
Your answer
Participants Surname
*
Your answer
Participants Age
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Your answer
Participants Gender
*
Female
Male
Prefer not to say
Other:
Date of Birth
*
MM
/
DD
/
YYYY
Week One (26th-29th July)Drama and Film Making 7-11
Yes
No
Clear selection
Week One (26th-29th July) Drama and Film making 12-19
Yes
No
Clear selection
Week Two (2nd-5th Aug) Dance takeover UMD 7-11
Yes
No
Clear selection
Week Two (2nd-5th Aug) Dance takeover UMD 12-19
yes
No
Clear selection
Week Three (9th-12th Aug) Drama Fun 7-11
Yes
No
Clear selection
Week Three (9th-12th Aug) Artivism 12-19
Yes
No
Clear selection
Week Four (16th-19th Aug) Art&Music 7-11
Yes
No
Clear selection
Week Four (16th-19th Aug) Comedy 12-19
Yes
No
Clear selection
Week Five (23rd-26th Aug) Musical Theatre 7-11
Yes
No
Clear selection
Week Five (23rd-26th Aug) Film Making for social media 13-19
Yes
No
Clear selection
Please giver details of any participants medical or allergies that it would be useful for us to be aware of (e.g. diabetes, epilepsy, asthma, hay fever etc.)
Your answer
Parent/Guardian First name
*
Your answer
Parent/Guardian surname
*
Your answer
Parent/Guardian Contact Number
*
Your answer
Parent Guardian Email Address
*
Your answer
Postal Address
*
Your answer
Postcode
*
Your answer
Young Person Contact Number (if applicable)
Your answer
I consent to participant receiving first aid if necessary
*
Yes
No
Required
I consent to participant going home alone
*
Yes
No
I consent to participant leaving the building for lunch (over 11 only)
*
Yes
No
I give permission for m child to go outside to various locations such as the park as part of this project
*
Yes
No
I consent to Hoxton Hall using images/video footage of the participant for promotional reasons and social media
*
Yes
No
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