Sign Up - A Week of Creative Film-Making

Required fields are marked with an asterisk (*).

Participants Information

Full Name *

Date of Birth *

Any dietary restrictions or allergies

Special Interests or skills (Optional)

Parent/Guardian's Information

Full Name *

Relationship to Participant *

Contact Number *

Email *

Emergency Contact Information

Full Name *

Relationship to Participant *

Contact Number *

Consent

Photo & Film Consent - I consent to the capture and use of photographs and/or video footage of the participant named above. * By ticking the box below, I hereby grant permission to Roxby Council, Emmaline Zanelli (Artist) and associates to capture photographs and/or video footage of the named participant for the purpose of this project. I understand that these may be used in future marketing material, social media platforms, and other forms of media associated with this project. An additional consent form from the artist will need to be completed, this will be emailed to the parent/guardian once registration is completed.

Parent / Guardian Consent * By ticking the box below, I certify that I am the parent or legal guardian of the participant named above. I hereby grant permission for them to participate in all activities during and ongoing through the "Emmaline the Artist Visit" project.

Community

Sign Up - A Week of Creative Film-Making

Contact Council

Connect with Roxby Council

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