Art Activities Consent Form OCTOBER 2023

CONSENT FOR ART ACTIVITIES

Fill out the form carefully for registration for OCTOBER HALF TERM #YES 2023 Art/Craft/BSL Activities 8-16 (25 with EHCP). MONDAY 30th OCT – FRIDAY 3rd NOV 2023. These sessions are free and all materials and a lunch are provided, they are accessible to most young people living in Wolverhampton and no previous art skills are needed. Location: The Workspace at ASAN, All Saints Road, WV2 1EL. Sessions start at 10am prompt, and finish at 2.30pm. Contact Real Arts Workshops with any queries: realartsworkshops@gmail.com Tel: 07882 685923
YOUR Name*

First NameLast Name
Email Address
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact 1 : NAME (REQUIRED)*
Emergency Contact 1 : Phone number (REQUIRED)*

Area CodePhone Number
Emergency Contact 2 : NAME (DESIRED)
Emergency Contact 2 : Phone number (DESIRED)

Area CodePhone Number
CHILD's Name 1*

First NameLast Name
Birth Date*

DayMonthYear
AGE*
School Name
School type

PrimarySecondary
CHILD's Name 2

First NameLast Name
Birth Date

DayMonthYear
AGE
School Name
School type

PrimarySecondary
CHILD's Name 3

First NameLast Name
Birth Date

DayMonthYear
AGE
School Name
School type

PrimarySecondary
CHILD's Name 4

First NameLast Name
Birth Date

DayMonthYear
AGE
School Name
School type

PrimarySecondary
Food is included in this project
My child(ren) has the following allergies:
My child(ren) has the following dietary requirements:
Any other illnesses / medications we should know about:
Preferred Attendance

We will do our best to accommodate preferred choices, but will be in touch if necessary to discuss.
I would like my young person(s) to attend*

THE FULL WEEK - OR (choose below)MON 30 OCTTUES 31 OCTWED 1 NOVTHURS 2 NOVFRI 3 NOV
We are following the funder's guidlines below:

"If a child does not attend a session and we have not been notified of the absence, sickness etc. within 45 minutes of the session start time, we reserve the right to cancel your booking(s) for the respective day, AND the reminder of the holiday period. The vacant place would then be offered to a child on our waiting list"

Therefore, please keep us updated if there are any changes to your booking.
COVID 19
(Please tick)*

I confirm that myself / my child is not experiencing any symptoms of Covid: for example a new and consistent cough / high temperature / loss of sense of taste or smellI confirm that myself / my child has not recently tested positive for Covid-19I confirm that myself / my child is not shielding or been asked to self isolate
Photography and Video.
Real Arts Workshops (RAW) would like to be able to share photographs and video of the work created by young people on this project across their social media channels and with City of Wolverhampton Council.
This includes our website, YouTube, FaceBook, LinkedIn, Instagram and Twitter. We don't usually take photos of childrens' faces, just hands and work being made, unless we have agreement from the child / parent.
Please tick the box to confirm whether or not this type of photography and sharing is acceptable.*

YESNO
MONITORING INFORMATION

All information will be treated as strictly confidential and only shared with the funders of this project. All data will be collected and stored in accordance with the General Data Protection Regulation 2018.
Ethnicity, please ‘x’ the one that best describes your CHILD 1:

Asian or Asian BritishBlack, Black British, Caribbean or AfricanMixed or multiple ethnic groupsWhiteOther Ethnic GroupPrefer not to sayUnknown
Gender CHILD 1

MaleFemaleNon BinaryPrefer not to sayI use another term
Do you consider your child (1) has a Special Educational Need or disability?

YESNOPREFER NOT TO SAY
Details (optional)
Ethnicity, please ‘x’ the one that best describes your CHILD 2:

Asian or Asian BritishBlack, Black British, Caribbean or AfricanMixed or multiple ethnic groupsWhiteOther Ethnic GroupPrefer not to sayUnknown
Gender CHILD 2

MaleFemaleNon BinaryPrefer not to sayI use another term
Do you consider your child (2) has a Special Educational Need or disability?

YESNOPREFER NOT TO SAY
Details (optional)
Ethnicity, please ‘x’ the one that best describes your CHILD 3:

Asian or Asian BritishBlack, Black British, Caribbean or AfricanMixed or multiple ethnic groupsWhiteOther Ethnic GroupPrefer not to sayUnknown
Gender CHILD 3

MaleFemaleNon BinaryPrefer not to sayI use another term
Do you consider your child (3) has a Special Educational Need or disability?

YESNOPREFER NOT TO SAY
Details (optional)
Ethnicity, please ‘x’ the one that best describes your CHILD 4:

Asian or Asian BritishBlack, Black British, Caribbean or AfricanMixed or multiple ethnic groupsWhiteOther Ethnic GroupPrefer not to sayUnknown
Gender CHILD 4

MaleFemaleNon BinaryPrefer not to sayI use another term
Do you consider your child (4) has a Special Educational Need or disability?

YESNOPREFER NOT TO SAY
Details (optional)
Any other information you think we should know about:
I give permission for the child(ren) in my care to take part in the activity and for monitoring data to be shared as detailed above.*

YES
Signature*

Clear
Should be Empty:

CONSENT FOR ART ACTIVITIES

Food is included in this project

Preferred Attendance

COVID 19

Photography and Video.

MONITORING INFORMATION