ACE Membership Form

ACE Membership Form
Name*

First NameMiddle NameLast Name
Date of birth*

MonthDayYear
Date
Gender*

MaleFemaleTransNon-binaryPrefer not to say
Ethnicity*

Black BritishBlack CaribbeanBlack AfricanBlack otherBritish AsianIndianPakistaniBangladeshiChineseAsian otherWhite BritishWhite IrishWhite EuropeanWhite otherWhite/BlackWhite/AsianBlack/AsianMixed otherPrefer not to sy
Sexual orientation - please only indicate your sexual orientation if you are 13 years old or over*

StraightGayBi / PanPrefer not to sayI am 12 years old or younger
Phone number*
Email
example@example.com
Socials
Instagram etc.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation*

Primary schoolSecondary schoolCollegeUniversityNon mainstream schoolingHome schoolingPart time employmentFull time employmentSelf employedUnemployed
Medical conditions - please specify any medication*
Please tick any that apply:

Single parent familyLow income householdProblems at homeOffender (or at risk of offending)Looked after child (in care)Young carerSpecial Educational NeedsPhysical disabilityMental ill healthRefugee / Asylum seekerEnglish is a second languageNonePrefer not to answer
How can ACE help you develop?*

Music makingMusic performanceMusic theory / businessOther media skillsOther arts skillsMentoringBuilding confidenceTrying new thingsNurturing your talentsEducation / employment / trainingOther
Please rate your skills & knowledge from 1 (poor) to 5 (excellent):

12345
Please rate your self-confidence from 1 (poor) to 5 (excellent):

12345
Please rate how well you manage your behaviour from 1 (poor) to 5 (excellent):

12345
Please rate your communication skills from 1 (poor) to 5 (excellent):

12345
Please rate how well you maintain your health & wellbeing from 1 (poor) to 5 (excellent):

12345
Please rate how well you maintain positive relationships from 1 (poor) to 5 (excellent):

12345
Please rate your life aspirations and values from 1 (poor) to 5 (excellent)

12345
Engagement with ACE may include face to face sessions (either one-to-one or group sessions), or may be using communication devices (computers, tablets, phone etc) , which may involve the use of phone calls, video chats, social media, emails, text messages etc.

ACE will endeavour to provide a safe, creative and fun environment.

ACE will endeavour to help and support our beneficiaries where necessary.

ACE will endeavour to put our beneficiaries at forefront of our operations.

ACE has the right to store and use all materials produced during our provisions; including photos, videos, music, designs & literature as we see fit - including sharing with our delivery partners listed in below and on our website.

Intellectual ownership of the materials produced within ACE’s provisions will belong to the creator(s).

Participants will contribute to all of ACE’s activities with respect for other participants, staff, the building, equipment and facilities.

Participant will co-operate with ACE's overarching aim to develop and better Beneficiaries’ lives through Arts Activities, Role-Model Guidance and Inspirational Experiences.

Participants will be fully liable for any damages caused by them, and will be responsible for any resulting replacements or repairs.

Participants may be dismissed, banned or even reported to the authorities if they breach this agreement.
Name of parent / legal guardian / emergency contact*

First NameLast Name
Relationship of parent / legal guardian / emergency contact e.g. mum, dad, carer.*
Phone Number of parent / legal guardian / emergency contact*
Email address of parent / legal guardian / emergency contact
example@example.com
I understand that this information will be securely stored by Aspiration Creation Elevation (ACE) and may be shared with their key delivery partners (Full circle@Docklands, Creative Youth Network, Basement Studios, Trinity, and Bristol City Council), and with organisations providing funding for the activities delivered by ACE.

I understand that ACE will not share the information with any other 3rd party organisation or individual, and that ACE plans to use this information for anonymous data analysis, communicating opportunities and making contact regarding my interactions with the company.

Aspiration Creation Elevation will update your details or delete your named information imediately on written request.
I agree to the following methods of using my information:*

Storage - we need this information so you can attend our sessionsStatistics - we need this information for anonymous data analysisEmail - to inform you of opportunities. We won't share with third parties except as detailed above.Telephone
I agree to the terms set out in this document, and I am happy for ACE to publically use audio and visual materials in which I can be seen or heard.
Signature*

Clear
Date of signature*

MonthDayYear
Date
We're always happy to hear from those we serve (including complaints, compliments and queries), so feel free to get in-touch with us at info@acecicteam.com

Additionally, you can see our company policies and procedures here: https://drive.google.com/drive/folders/1vgmNWX_SuCENKaeUXbhdunW9huFPQkVN?usp=sharing

One last thing!

Follow us on Instagram to stay up to date with our latest opportunties: @ACE_CIC
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