Holiday project sign up: 11- 16
Identity
Title
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Mr
Miss
Mrs
Ms
Dr
First Name
Middle Name
Last Name
Pronouns
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He/Him
She/Her
Them/They
Date Of Birth
Address
Address1
Address2
Town
Borough
Post Code
Housing Association
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Ekaya HousingAssociation Ltd
Angell Town RMO Ltd
Barbican Estate Office
Ash Shahada Housing Association
Parkhill Housing
Viridian Housing
Shaftesbury Housing Group
Thorlans Housing Management Society
Camberwell Neighbourhood Office
Guinness Trust
Loughborough Estate Management
Unknown
Not Applicable
City
Contact
Email
Mobile
Emergency Contact
Title
Full Name
Relationship to Participant
Mobile
Email
Content Consent
I give my consent / permission for my artistic content created during Raw Material sessions, to be used if required on Raw Materials social media and website
Please choose a value
Yes
No
Prefer not to say
Demographic
Gender
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Female
Male
Nonbinary
Female Transgender
Male Transgender
Prefer not to say
Cultural background
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Asian/Asian British
Black/African/Caribbean/Black British
Prefer not to say
White
White and Black African
White and Black Caribbean
Medical/Dietary needs
Do you have any special medical or dietary needs we should know
Parental Consent to Participation
Date of Consent
Parental/Guardian Consent Required (participants under 18)
Please choose a value
I have received consent from a parent/guardian to participate.
Other
I understand I will need to bring a packed lunch
YES
NO
Education & Employment
Education
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Full-Time
Part-Time
No
Employment
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Full-Time
Part-Time
No
Media Consent
I give my consent / permission for photos and videos to be taken during the project, to be used if required on Raw Materials social media and website
Please choose a value
Yes
No
Prefer not to say
Parental/guardian media consent
Please choose a value
Yes
No
Prefer not to say
Date of consent
Programme
How did you hear about Raw Material?
Submit
Please confirm the following details are correct
×
Media Consent
I give my consent / permission for photos and videos to be taken during the project, to be used if required on Raw Materials social media and website
Parental/guardian media consent
Date of consent