Summer Band Project
Identity
Title
Please Select
Mr
Miss
Mrs
Ms
Dr
First Name
Middle Name
Last Name
Pronouns
Please Select
He/Him
She/Her
Them/They
Which name do you like to be known as?
Date Of Birth
Day
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Year
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1918
1917
1916
1915
1914
1913
1912
1911
1910
Demographic
Gender
Please choose a value
Female
Male
Nonbinary
Female Transgender
Male Transgender
Prefer not to say
Cultural background
Please Select
Asian/Asian British
Black/African/Caribbean/Black British
Prefer not to say
White
White and Black African
White and Black Caribbean
Address
Address1
Address2
Town
Borough
Post Code
Housing Association
Please Select
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
Mental Health Services
Is the participant currently engaged with mental health services
Please Select
Yes
No
Prefer not to say
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
Medical/Dietary needs
Do you have any special medical or dietary needs we should know
Parental Consent to Participation
Date of Consent
Day
1st
2nd
3rd
4th
5th
6th
7th
8th
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29th
30th
31st
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
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1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
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1938
1937
1936
1935
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1932
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1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
Parental/Guardian Consent Required (participants under 18)
Please Select
I have received consent from a parent/guardian to participate.
Other
I understand I will need to bring a packed lunch
YES
NO
Support
Why are you applying for this bursary? ( one or two sentences )
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 Select
Yes
No
Prefer not to say
Parental/guardian media consent
Please Select
Yes
No
Prefer not to say
Date of consent
Day
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
Programme
Why you are interested in this project?
Was this form completed by a participant or care coordinator?
Please Select
Participant
Care Coordinator
Someone Else
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
Please Select
Parental/guardian media consent
Please Select
Date of consent