ADP Design Registration Form 2019

ADP 2019 Design Sign Up.

Thank you for choosing to register with us. Hackney Empire will process your data in accordance with the General Data Protection Regulation (GDPR). Hackney Empire will use your information for administration, marketing and charitable purposes, and will not share your personal details with third parties without your consent. This project is funded by Hackney Council who will receive your data for equality and diversity monitoring purposes, if you have any comments or concerns regarding the use of your data, please contact us at projects@hackneyempire.co.uk

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* 1. The Artist Development Programme is for participants aged 13-19 years old. The project dates are from 27th July-9th August 2019. Please confirm you are within this age range and available for the dates of the programme.

I confirm I or the named applicant is aged 13-19 years old

I confirm I am available for the project dates: 27th July-9th August 2019.

I am outside of this age range, please contact projects@hackneyempire.co.uk

I am unable to confirm my availability for the programme, please contact projects@hackneyempire.co.uk

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* 2. Personal Details

First Name *

Surname *

Date of Birth *

House Number/Name

Street Name *

City/Town

Postal Code *

Email Address *

Phone Number *

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* 3. Education (where applicable)

Name of School/College

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* 4. We collect ethnicity and gender information to monitor equality and diversity. This information is given to our funders Hackney Council. Please select your ethnicity from the drop down list below or select prefer not say.

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* 5. Gender

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* 6. What Design experience do you have?

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* 7. Why would you like to be a part of the ADP Design team?

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* 8. What would you gain from being a part of the ADP Design department?

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* 9.
Parent/ Carer/ Emergency Contact Details

Full Name

Relationship to applicant

Email Address

Phone Number

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* 10. Do you have any medical conditions/disabilities/access requirements you would like us to know about?

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* 11. PARENTAL /GUARDIAN CONSENT FOR U-18s // PERSONAL CONSENT FOR 18+. Please note you will need to complete a signed form if you are selected.

I consent for the above participant to take part in the Creative Learning Programme at Hackney Empire.
I consent to the use of all audio and visual recordings of the above participant for the purpose of marketing and evaluation here at the Hackney Empire.

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* 12. How did you find out about us?

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* 13. Would you like to hear about future Creative Learning Opportunities at Hackney Empire?

Yes- I am happy to be contacted by Hackney Empire about further opportunities by email

Yes- I am happy to be contacted by Hackney Empire about further opportunities by phone

Question Title

* 1. The Artist Development Programme is for participants aged 13-19 years old. The project dates are from 27th July-9th August 2019. Please confirm you are within this age range and available for the dates of the programme.

Question Title

* 2. Personal Details

Question Title

* 3. Education (where applicable)

Question Title

* 4. We collect ethnicity and gender information to monitor equality and diversity. This information is given to our funders Hackney Council. Please select your ethnicity from the drop down list below or select prefer not say.

Question Title

* 5. Gender

Question Title

* 6. What Design experience do you have?

Question Title

* 7. Why would you like to be a part of the ADP Design team?

Question Title

* 8. What would you gain from being a part of the ADP Design department?

Question Title

* 9. Parent/ Carer/ Emergency Contact Details

Question Title

* 10. Do you have any medical conditions/disabilities/access requirements you would like us to know about?

Question Title

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* 12. How did you find out about us?

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* 13. Would you like to hear about future Creative Learning Opportunities at Hackney Empire?

* 9.
Parent/ Carer/ Emergency Contact Details