Mess Up The Mess Online Registration FormTo register for Mess Up The Mess activities, please complete this form. If you're under the age of 18, we'll need a parent or carer to confirm they consent to you taking part. It may be useful for you to fill in the form together. We need this information so that we can run our activities safely and make sure we're doing everything we can to support you to take part. We also collect some information so that we can tell our funders about what we've done and how many people have benefited. We take your privacy seriously. We will only share your personal information in certain limited circumstances (for safety) or with your permission. You can read more about what information we collect and what we do with it in our Privacy Notice. Personal InformationFirst NameYour 'official' name. This is the name we will use if we write to you.Middle Name(s)Last NamePreferred Name (optional)This is the name you like to be called byHouse Number and Street AddressTown / CityCountyPostcodeYour Email AddressDate of BirthYour Phone NumberEducation, Employment and TrainingWhich best describes your current education and employmentAt SchoolAt CollegeAt UniversityHome EducatedUnemployedEmployedIn TrainingNot in Employment Education or TrainingRetiredSchool College or University NameLanguageDo you speak Welsh?YesNoGender IdentityGenderDo you identify as Trans?YesNoPrefer not to sayPronounsHow we can support youDo you consider yourself to be disabled?YesNoPrefer not to sayDo you consider yourself to have a learning difficulty?YesNoPrefer not to sayDo you have any mental health conditions you think we should be aware of?YesNoPrefer not to sayIf so, please let us know of anything we can do to help you access Mess Up The Mess0 / 200Do you have any medical conditions you think we should be aware of?YesNoPrefer not to sayDo you have any allergies you think we should be aware of?YesNoPrefer not to sayPlease give any details you think we should be aware of0 / 200Dietary RequirementsNoneVegetarianVeganDairy FreeGluten FreeHalalKosherOtherOther Dietary Requirements0 / 200Please give details of anything else you think we need to know to help you access Mess Up The Mess0 / 200Emergency ContactsIn an emergency, who do we contact?Emergency Contact NameRelationship to youParentFoster CarerGrand ParentSiblingOther Family MemberPartnerOtherIf other, please stateMobileLandlineAlternativeEmail AddressPhotos and VideosInformation about Photography and FilmingMess Up The Mess aims to provide a safe and enjoyable experience for every child or young person. To help us do this, please note the following important information: We recognise the need to ensure the welfare and safety of all children and young people. We will not take or share photographs, video or other images of children and young people without the consent of the children and young people involved and their parents or carers. This agreement fits with our overarching safeguarding policy. If you would like to know more about this, please speak to Chris Lewis, Executive Director.I agree to photographs of me being usedFor display purposesIn print publicationsOn the Mess Up The Mess websiteOn Mess Up The Mess Social Media PagesIn public exhibitionsBy project partners on their websitesBy project partners on their social mediaI agree to videos of me being usedOn the Mess Up The Mess WebsiteOn Mess Up The Mess Social Media PagesIn public screenings by Mess Up The MessBy project partners on their websitesBy project partners in their social media pagesParticipants, please type your full name here to confirm your consent *If you are under 16, please get a parent or carer to confirm their consent to us using photographs and videos of you by typing their full name hereMarketing ConsentMarketing Mess Up The Mess would like to contact you about this and other activities we provide. Please tell us how you would like us to contact you and what you’d like us to contact you about. I would like to be contacted byPhoneText MessageEmailPostI would like to be contacted aboutDrama sessionsShows and performancesCreative projects I can get involved inTraining and CoursesInformation from Mess Up The Mess partnersConsent to Take PartConsent to Attend Mess Up The Mess Online ActivitiesIf you are under the age of 18, please get a parent or carer to read through this form with you and confirm they are happy for you to take part. Parent / Carer Please make sure you have read all the information in this form and that you are happy for your child to take part in Mess Up The Mess online activities including live video workshops. Please make sure that you agree with the Working Online Agreement. Please also ensure you will read the terms and conditions of the video platform(s) used and make sure it is suitable for the participant before the session starts. Please type your full name below to indicate your consent.I consent to the aboveGDPR Privacy NoticeGDPRTo run Mess Up The Mess activities safely we need to record and process information about you. We take good care of this information and will only use it for limited purposes. Our Privacy Notice explains how we collect, use and share this information and your rights to access, correct and delete this information. Please read our Privacy Notice and confirm below that you have read and understood it.Participants, please confirm you have read and the Privacy Notice *I have read and understand the Privacy NoticeIf you are under 16, please ask a parent or carer to confirm they have read the privacy notice by typing their full name hereSubmitPlease do not fill in this field.
