Activity Consent Form MCC Art Club

EMPOWER WALSALL - ART CLUB

REGISTRATION FORM
Thank you for your interest in our Art Club. These have been funded by the organisations named above which means they are free to you. All tuition and materials are included and you have the option to make a suggested donation of £1. All personal belongings are at the owners own risk.
The sessions will run on Monday afternoons for 13 weeks, 1-3pm in the Community Day Room at Housing 21, Mattesley Court, Cresswell Crescent, Mossley, Walsall WS3 2US.
All the data submitted below will be treated in accordance to our GDPR / Data Protection policy which is available upon request.
Your Details:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone number

Area CodePhone Number
I confirm I am over 18 (this sessions are for adults only)*

YES
Where did you hear about us?*
Other (please specify)
There will be light refreshments, please tell us about any allergies / other health conditions we should know about or say 'none':
Are there any artforms you are particularly interested in learning about?
Attendance
These sessions run every Monday 1-3pm starting on 18th March 2023 for 13 weeks (excluding 1st April). Please let us know if there any dates that you know you won't be able to attend.
COVID 19
Please do not attend the session if you are experiencing Covid symptoms or have tested positive for Covid.
Photography and Video.
We would like to be able to share photographs and video of the work created on this project across our social media channels. This includes our website, YouTube, FaceBook, LinkedIn, Instagram and Twitter accounts. Photos/videos may also be shared with the funders.
Are you happy to consent to this type of photography and sharing?*

YESNO
Do you have any specific access requirements?

YESNO
If 'yes' please tell us about that here:
OPTIONAL: Are you interested in volunteering for our organisation?

YESNO
Any other information you think we should know:
USE OF YOUR DATA

All information will be treated as strictly confidential by MCC. High level summaries may be shared with the funders. All data will be collected and stored in accordance with the GDPR 2018 guidelines. Data may be provided to the funders upon an audit or monitoring visit.
CONSENT
I agree to take part in the activity and for monitoring data to be shared as detailed above.*

YES
Signature*

Clear
Should be Empty:

EMPOWER WALSALL - ART CLUB

Your Details:

Attendance

COVID 19

Photography and Video.

USE OF YOUR DATA

CONSENT