Term 4 Enrolment form (Face to Face)
Please provide complete and accurate information and inform us of any changes. Communication regarding course groups will usually be via email or text.
These sessions will be held at Open Source Arts, LS3 1JL, opposite ITV studios on Kirkstall Road. Ableton Live (sound production will be held at the Cardigan Centre, 145-149 Cardigan Road, Burley, Leeds, LS6 1LJ (5 minute car ride from Open Source Arts). Some sessions will be at Old Chapel Studios, 1 Crossland Court, Czar Street, Holbeck, Leeds, LS11 9PR.
Your email is for Cloth Cat purposes only, it will not be used for any other purpose unless consent is given in one of the questions below.
* Required
Email address
*
Your email
Childs name
*
Your answer
Parent/Carer's name
*
Your answer
Childs date of birth (dd/mm/yy)
*
Your answer
Home address
*
Your answer
Postal code
*
Your answer
Gender
*
Female
Male
Prefer not to say
Other:
Childs email (optional)
Your answer
Childs mobile (optional)
Your answer
Home phone number
Your answer
Parent/Carer mobile number
*
Your answer
Mailing list consent
We would like to input your email into MailChimp (a company which complies with GDPR) in order to keep you updated with newsletters and relevant volunteering information? For further information about Mailchimp, please refer to this website address;
www.mailchimp.com
or to register yourself to receive the updates please visit
http://eepurl.com/bQNXej
to enter your details.
Mailing list consent
*
Yes
No
Required
Childs School/College
*
Your answer
Childs Year Group in September
Yr 6
Yr 7
Yr 8
Yr 9
Yr 10
Yr 11
Yr 12
Other:
Clear selection
Emergency Contact details
the details given below are for emergency purposes only and will not be shared with any 3rd party outside of Cloth Cat.
Dr's name and address
*
Your answer
Dr's phone number
*
Your answer
Any medical or SEN information about your child (please state any allergies or medication)
Your answer
Any other relevant information about child (i.e. plays an instrument, has singing lessons or requires additional support.
Your answer
Our music sessions starting 19.04.2021 - 05.07.2021 (we will break for half term 31.05.21)
Monday - Ableton Live with Dan 5-6.30 at the Cardigan Centre
Monday - 'Let Us Gig' forma band with Rob 5-6.30 at Old Chapel Studios
Tuesday - Guitar with Jack 5.00-6.30 at Open Source Arts
Wednesday - DJ'ing with Dan 5.00-6.30 at Old Chapel Studios
Thursday - Radio Cloth Cat (create a radio show) with Lisa & Mick 5.00-6.30 and Open Source Arts
Friday - Keyboards with Matti 5.00-6.30 at Old Chapel Studios
Sessions you wish to attend?
*
Guitar
Keyboards
'Let Us Gig'
Radio Cast Cloth Cat
Required
Does your child have the instrument required for the course and able to bring it with them?
*
Yes
No
Safeguarding
We have a legal obligation to safeguard your child when they are in our care, please answer the following questions.
How will your child arrive to their session
*
Car
Taxi
Bus
Walk
Will you be staying with your child in the designated waiting area?
*
Yes
No
Maybe
Permissions
We may film some of our sessions for promotional use or evidence to our funder of the work we are doing. If we are filming for evidence purposes this will be passed to our funder and not shared with any other party.
We will also be live streaming the sessions so young people at home can watch if they are unable to attend. Please select options you are happy with below
Do you give consent for your child to be filmed?
*
Yes (for all)
Yes (for funder evidance)
No
If you give permission to film your child for any use, please tick all categories for which you give consent
*
Publicity leaflets or other printed publications
Promotional films
Authorised websites and social media including YouTube
News media and/or press releases
Live stream during lesson via Cloth Cat YouTube channel
Live stream during lesson via Open Source channels
None
Required
Parent Information
This information will only be shared with our funder for evidence, it will not have your personal information attached to it, it is for statistical purposes only.
Are you in receipt of any benefits?
*
Yes
No
If yes please state which
*
NONE
Carer's Allowance
Child Benefit
Child Tax credit
Disability Living Allowance
Free School meals
Housing Benefit
Incapacity Benefit
Income Support
Job Seekers Allowance
Personal Independance Payment (PIP)
Univeral Credit
Working Tax credit
Other:
Required
Do you give consent for your child to attend our course?
*
Yes
No
Thank you
The form is now complete and a member of the Cloth Cat team will be in contact to confirm if your child has a place on one of our courses.
Data Protection Act 1998 & General Data Protection Regulation. By signing this form, you are consenting to Cloth Cat Studios using the information to process your application for membership of the Get Your Act Together Courses. Your information will not be disclosed outside of Cloth Cat Studios without your consent, except where we are required to do so by law. Cloth Cat Studios is required to submit anonymised data to The National Lottery and will ensure compliance, in line with Cloth Cat Studios obligations under the Data Protection Act 1998 and the General Data Protection Regulation.
Cloth Cat Studios Ltd, The Old Chapel, 1 Crossland Court, Czar Street, Leeds, LS11 9PR. Tel: 0113 2442773
enquiries@clothcatleeds.org.uk
. Cloth Cat Studios Ltd is registered with the Financial Conduct Authority as an Industrial & Provident Society for the benefit of the community, registered in England No. 28890R and as a charity with the Inland Revenue ref. XR31169
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Cloth Cat Studios LTD.
Report Abuse
Forms
