Hoxton Hall Summer Holiday Program 2021
In order to ensure the safety of all of our participants this form must be completed fully by all parents/guardians. By filling out this form you give permission for the London Borough of Hackney Youth Service to collect and store personal data about your child and the activities which they participate in for monitoring purposes. You hereby understand the data will be held in line with the Data Protection Act 1998 and subsequent updates and amendments.

Please fill out one form per participant.

Participants First Name *
Participants Surname *
Participants Age *
Participants Gender *
Date of Birth *
MM
/
DD
/
YYYY
Week One (26th-29th July)Drama and Film Making 7-11
Clear selection
Week One (26th-29th July) Drama and Film making 12-19
Clear selection
Week Two (2nd-5th Aug) Dance takeover UMD 7-11
Clear selection
Week Two (2nd-5th Aug) Dance takeover UMD 12-19
Clear selection
Week Three (9th-12th Aug) Drama Fun 7-11
Clear selection
Week Three (9th-12th Aug) Artivism 12-19
Clear selection
Week Four (16th-19th Aug) Art&Music 7-11
Clear selection
Week Four (16th-19th Aug) Comedy 12-19
Clear selection
Week Five (23rd-26th Aug) Musical Theatre 7-11
Clear selection
Week Five (23rd-26th Aug) Film Making for social media 13-19
Clear selection
Please giver details of any participants medical or allergies that it would be useful for us to be aware of (e.g. diabetes, epilepsy, asthma, hay fever etc.)
Parent/Guardian First name *
Parent/Guardian surname *
Parent/Guardian Contact Number *
Parent Guardian Email Address *
Postal Address *
Postcode *
Young Person Contact Number (if applicable)
I consent to participant receiving first aid if necessary *
Required
I consent to participant going home alone *
I consent to participant leaving the building for lunch (over 11 only) *
I give permission for m child to go outside to various locations such as the park as part of this project *
I consent to Hoxton Hall using images/video footage of the participant for promotional reasons and social media *
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