THE LAB Cohort 3 (Barrow)
Participant's Name
*
First Name
Last Name
Gender of Participant
*
Female
Male
Prefer not to say
Which educational setting does participant attend?
*
Can attend sessions on Mondays 4:30pm-6:30pm
*
Yes
No
Key Stage?
*
Contact Email Address
*
example@example.com
Ethnicity of Participant
*
Date of Birth (Participant)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Participant's Address
*
Participant/ Guardian's Name (if participant is under 16)
*
First Name
Last Name
Participant/ Guardian's Number (if participant is under 16)
*
Emergency Contact
*
First Name
Last Name
Relationship to Participant
*
Emergency Contact Number
*
Please tick any statement that is appropriate to you
*
Eligible for Pupil Premium
SEND
Both Pupil Premium and SEND
Child of currently or former Serving Armed Forces
I prefer not to say
Do you have any allergies including food or medical conditions we should be aware of?
*
Do you have any accessibility needs?
*
Is there anything else we need to know?
*
Why do you want to join The Lab?
*
Consent
*
I allow the photos of my child/participant to be used in promotions of Horizon Studios future projects.
I don't consent
*
I allow the photos of my child/participant to be used by partners of Horizon Studios for promotions.
I don't consent
*
I consent to my information being collected, stored, and shared with relevant partners for the purposes of evaluation and reporting.
I don't consent
*
Westmorland & Furness Music Service, as the lead organisation of Cumbria Music Hub, would like to take audio, video and photos during rehearsals and events. Our purpose for taking photographs/film: - For keeping a record of the project - For the purpose of monitoring and evaluation to report back to our funders - For promoting future projects The photographs/films we take may be used in any of the following ways: - For publishing on the Westmorland and Furness Website, For production of still images to be used in print and online publicity - For inclusion in promotional films for Westmorland & Furness Music Services and Music Hub projects - For publicising on Westmorland & Furness Music Services and Music Education Hub social media accounts (Twitter, Instagram, Flickr and Facebook) - For public display at locations where Cumbria Music Hub or Music Services carry out their business. - For relevant partners to use in the same way as statements listed above on their own websites and publicity. Photographs or film will be stored securely for three years after which they will be destroyed. No child will be identified by name unless we have specifically requested your permission for this. To withdraw your permissions at a future point, or if you have any questions, then please contact the project manager.
I don't consent
Submit
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