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Summer Sparks at Building Blocks Registration Form

Please complete this form to register interest in a Summer Sparks workshop at Building Blocks.

About you

Please tell us about the person completing this form. We’ll use these details to contact you about the booking.

Name(Required)

First Last

Phone(Required)

Email(Required)

Keeping in touch

We will use the contact details you provide to keep in touch with parents, guardians and carers about the event.

If you would like to hear about other free and low-cost creative activities for families, children and young people in Sunderland, please tick the box below.

Consent

Yes, I would like to hear from Sunderland Culture.

About the child

Please provide details of the child you would like to take part.

Name(Required)

First Last

Date of Birth(Required)

Day

Month

Year

Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Child's School(Required)

Your relationship to the child(Required)

Allergies / Medical Conditions(Required)

Yes

Does the child have any allergies or medical conditions that you think the Culture Start team should be aware of?

Allergy / Medical Condition Details(Required)

Please provide details:

Access Requirements(Required)

Yes

Does the child have any Access Requirements that you think the Culture Start team should be aware of?

Access Requirements(Required)

Please provide details:

Do any of the following apply to the child?(Required)

Eligible for free school meals

Lives in a low-income household

Lives with a long-term health condition or disability

Has care experience including kinship care

Is a young carer

Has an Education Health and Care Plan in place

Has Special Educational Needs and/or a Disability

Is part of a family with a baby under one

Is part of a family where their mother is aged under 25

Has recently arrived in the UK and English is an additional language

Lives with a lone parent

Is part of a family with three or more children in the household

Is experiencing extenuating circumstances

None of the above

Prefer not to say

Travel

Does this child have permission to travel to and from the workshop unaccompanied?(Required)

Yes

No, they will be dropped off and collected by an adult

Approved Adult 1(Required)

Approved Adult 2

Approved Adult 3

Filming and photography

We sometimes take photographs of, and film, our events and activities. Sunderland Culture and Culture Start would like your permission to capture images of the child in your care through video, audio or photography.

These images would only be used to reasonably promote Culture Start and Sunderland Culture’s programmes.

Consent

I consent to the statement below.

I understand that:
- images will be held in accordance with the Data Protection Act 2018
- images captured in the video/audio recordings and/or photographs will be the copyright of Sunderland Culture and Culture Start and any other intellectual property which arises will also belong to Sunderland Culture and Culture Start
- images may also be shared with trusted project and funding partners to reasonably promote Sunderland Culture and Culture Start
- I can ask Sunderland Culture and Culture Start to stop using images at any time, in which case they will not be used in future publications, but may continue to appear in publications and material already in circulation

Name

This field is for validation purposes and should be left unchanged.

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