Participant first name

Participant surname

Date of birth

Age Age 16 or 17 18 to 21

Are you signing up the young person as: Are you signing up the young person as: Parent Guardian/Carer Other (please explain below)

If 'other' selected - please explain here

Guardian/Carer/Other title (Mr, Mrs etc)

Guardian/Carer/Other first name

Guardian/Carer/Other surname

Phone number

E-mail address

School or college (if not applicable put n/a)

Any medical details we should be aware of?

Any additional support required? (example, ADHD, Dyslexia, Autism etc)?

Any dietary needs we should be aware of?

Does the person attending the project have any criminal convictions or cautions? Does the person attending the project have any criminal convictions or cautions? Yes No

Emergency contact 1 (name & tel no)

Emergency contact 2 (name and tel no)

Confirmation Confirmation By submitting this form you are applying for a place on the Free Rap Workshop for the young person detailed in this form. The workshop takes place on Tuesdays. If 16 or 17 guardian/carer gives consent for their attendance.

Photographic Consent - Photography, Film and Audio: Milton Keynes Music Hub is part of MK Council and occasionally uses photography for publicity purposes. We would like your permission to photograph/film/record audio of your child for possible inclusion in promotional material, website and other publicity material including social media. We will ensure as far as possible that the images/video/audio are not used inappropriately but by submitting this permission form you accept that should this happen, the council does not accept responsibility. Your contact details will remain strictly confidential. Photographic Consent - Photography, Film and Audio: Milton Keynes Music Hub is part of MK Council and occasionally uses photography for publicity purposes. We would like your permission to photograph/film/record audio of your child for possible inclusion in promotional material, website and other publicity material including social media. We will ensure as far as possible that the images/video/audio are not used inappropriately but by submitting this permission form you accept that should this happen, the council does not accept responsibility. Your contact details will remain strictly confidential. I give photographic consent I do not give photographic consent