Registration form
VIEW FROM THE MAGPIE'S NEST TOODYAY 2021-22

Thank you for your interest in participating in View from the Magpie's Nest from October 2021 to March 2022. Please complete the following questions to register your position in the project and to grant consent for us to photograph, film and record you as part of the project.

Should you have any further questions, please contact:
Toodyay Community Resource Centre
Kyla Browne
08 9574 5357
events@toodyaycrc.com.au

The project schedule (download a copy from www.breaksea.org/toodyay)

OPEN WORKSHOP WEEKEND 1
Friday 15th October 2021 6 - 8pm Toodyay Memorial Hall
Saturday 16th October 2021 10:30am - 1pm Toodyay Memorial Hall

OPEN WORKSHOP WEEKEND 2
Friday 22nd October 2021 6 - 8pm Toodyay Memorial Hall
Saturday 23rd October 2021 10:30am - 1pm,
2 - 4pm Toodyay Memorial Hall

OPEN WORKSHOP WEEKEND 3
Friday 11th February 2022 6 - 8pm Toodyay Memorial Hall
Saturday 12th February 2022 10:30 - 1pm Toodyay Memorial Hall,
2 - 4pm Visual Arts Workshop Despina's Art Studio (NOW FULL)

OPEN WORKSHOP WEEKEND 4
Friday 11th March 2022 6 - 8pm Toodyay Memorial Hall
Saturday 12th March 2022 10:30 - 1pm Toodyay Memorial Hall,
2 - 4pm Visual Arts Workshop Despina's Art Studio (NOW FULL)

PRODUCTION WEEK
Wednesday 16th March 2022 6 - 8pm Toodyay Memorial Hall
Thursday 17th March 2022 6 - 8pm Toodyay Memorial Hall

DRESS REHEARSAL
Friday 18th March 2022 6 - 8pm Toodyay Memorial Hall

PERFORMANCE
Saturday 19th March 2022 6 - 8pm Toodyay Memorial Hall
Sign in to Google to save your progress. Learn more
I have checked my availability and I would like to register for:
Full name of participant *
Contact telephone *
Contact email *
What is your age? *
To which do you most identify? *
And finally, please provide your consent for the following:

I have read the project schedule and agree to participate to the full extend of my availability.

I understand that participating in this project will involve answering questions regarding View from the Magpie’s Nest in one or more of the following formats: Online survey, focus group, interview or journal entries.

I understand the risks associated with participating in this project which include mild social distress and physical injury. Community arts projects often involve sharing stories and basic physical activity.

I understand I may be asked to refrain from or to stop telling a story if the workshop facilitator identifies it as posing a psychological risk to other participants. Some themes may cause others distress.

I consent to having my voice audio recorded, image taken in photography and film during the project in the capacity of a workshop/ performance participant. These recordings may be publicly exhibited. Recordings will be kept in perpetuity.

I understand that I may be identified in audio recordings and interview transcripts.

That any creative contributions willingly given by participants to the project will remain the copyright of Breaksea Incorporated. If you wish to retain copyright of your work then you must keep it private, which you are welcome to do.

I understand that I can withdraw from the project/ research at any time without penalty.

Do you grant your consent? *
Required
If under 16 year of age, please provide name and contact telephone for guardian.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Breaksea Incorporated. Report Abuse
Google Forms