Piccadilly Unplugged! Ceramic Workshop

Participant's First Name

Participant's Second Name

Participant's DOB

Participant's Email

Participant's Phone Number

Participant's Home Postcode

Is the participant educated in Westminster?

Yes

Is the participant in receipt of free school meals?

Yes

Prefer not to say

Participant's Gender

Female (including trans female)

Male (including trans male)

Non-binary

All other gender identities

Prefer not to say

Participant's Ethnicity

Does the participant have a disability? Disability is defined by the Equality Act as: 'a physical or mental impairment that has a 'substantial' and 'long-term' negative effect on your ability to do normal daily activities'

Disabled under the Equality Act: Day-to-day activities limited a lot

Disabled under the Equality Act: Day-to-day activities limited a little

Not disabled under the Equality Act: Has long-term physical or mental health condition but day-to-day activities are not limited

Not disabled under the Equality Act: No long-term physical or mental health conditions

Prefer not to say

Do you have any dietary requirements? Please specify

Guardian's name

Guardian's Phone Number

Photographs and video images of participants may be taken and to be used for the purpose of promoting City Lions through the production of literature, displays, on the council's or our partners media. Do you consent to this?

Yes

Piccadilly Unplugged! Ceramic Workshop

Are you into space, ETs, and art? Do you want to learn how to make ceramic work and meet space experts!

Sign up now to get a chance to have your artwork exhibited in the centre of the West End in St James’s Market Pavilion, just off Piccadilly Circus!