Someday Leaders Registration Form
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Full Name (Please enter full name) *
DOB: *
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Please enter name of School/Organisation (if applicable):
Town/City: *
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Mobile: *
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Preferred Gender Pronouns - (more info: https://www.mypronouns.org/) *
Ethnicity:
Clear selection
Please tick other The Outlook for Someday programmes you have been involved in before
Clear selection
What are some of your favourite films or film genres?
What do you hope to learn from this workshop?
Do you have any dietary requirements?
Emergency contact - Name and Number
I understand that Connected Media Charitable Trust (‘Connected Media’) is running the sustainability film project for young people in 2021 called The Outlook for Someday ('the Project'), including a series of sustainability film-making workshops (Someday Workshops), a sustainability filmmaking leadership workshop (Someday Leaders),a sustainability film challenge (Someday Challenge) and a series of sustainability-focused short films by emerging young film-makers from Aotearoa New Zealand (Someday Stories). I agree to permit Connected Media, any workshop participant and anyone invited by Connected Media to visit a workshop to record me, my image and likeness, my voice and, if applicable, my musical performance on photographic, video and/or audio recording media.I give Connected Media, its licensees and its assignees the irrevocable and unlimited right to use my name and all or any part of the recordings as they may be edited by or on behalf of Connected Media at its discretion, for showing only in or in relation to the Project in perpetuity in/on any present or future media, including in advertising and publicity of the Project or any part of it or any derivative of it.I accept that Connected Media's use of this material will not invade my privacy.I understand that The Outlook for Someday is supported by several partner and funding organisations. I agree that Connected Media may share with those organisations my demographic details for statistical purposes.As an under 18 year old participant, I confirm that I have provided contact details of a parent, guardian or caregiver and that I will be appropriately supervised during the workshop. *
Required
If the participant is under 18 years of age we need additional confirmation from a parent / legal guardian / caregiver. We will send a Confirming Email with a link for them to click on so that they can agree to the above Terms. Please provide below: either an email address for a parent / legal guardian / caregiver or your email address if you would prefer to forward them the Confirming Email. If over 18 please write N/A. *
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