The Bomb Factory Foundation - Art Club Collective

Participant First Name

Participant Second Name

DOB

Email

Phone Number

Postcode

School

Gender Identity

Female (including transgender females)

Male (including transgender males)

Non-binary

Prefer not to say

Gender non-conforming

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

If 'yes', please specify:

Does the participant have any support needs?

Yes

No

If 'yes', please specify:

Does the participant have any medical needs (incl. any allergies or medication)?

Yes

No

If 'yes', please specify:

Has the participant attended any City Lions events or activity previously?

Yes

No

Not sure

Is the participant eligible for free school meals?

Yes

No

Not sure

Parent / Guardian's First Name

Parent / Guardian's Last Name

Phone Number

Email

The reason for collecting this data is to inform you about this event and future events. Your data will not be passed on to any third parties and will only be used internally. Do you consent to this?

Yes

No

By registering for programme you are providing consent for us to contact you in relation to the City Lions events and opportunities via the email/telephone details you have provided. Your data will not be passed on to any third parties and will only be used internally. Please see our privacy and GDPR policy for information on how your data will be used, stored and secured: https://citylions.org/privacy/

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?

Where did you hear about City Lions?

School/Youth Club

Through friends or family

City Lions newsletter / website / social media accounts

Westminster City Council newsletter/website / social media accounts

Other

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The Bomb Factory Foundation - Art Club Collective

The Bomb Factory Art Foundation - Art in Three Dimensions

Art in Three Dimensions is a new club where you’ll get to create art that you can touch, wear, and explore — from sculptures and installations to wild wearable art!