Registration and Consent Registration and Consent FormParticipant DetailsFirst Name*Last Name:*Date of Birth* (dd/mm/yyyy)AgeGenderMaleFemaleAddressHouse/Flat Number and Street*Address Line 2Town / City*Postcode*ContactTelephone*###########Mobile*###########Email*School(s) College(s) AttendedEthnicityPlease select one*Asian/Asian BritishBangladeshiIndianPakistaniAsian UKAsian OtherWhite/Black CaribbeanWhite/Black AfricanMixed HeritageWhite/White BritishIrishEuropeanWhite OtherOther Ethnic GroupBlack/Black BritishCaribbeanAfricanBlack OtherPrefer not to sayOtherIf Other, please explainAre you in education, training or employment?Please tick one* School College full time College part time University Employed Unemployed Career Voluntary work Prefer not to say OtherIf Other, please explainMedical InformationEmergency Contact*Enter full name of emergency contact personTelephone*###########Allergies?NoYesIf Yes, please state allergiesDisabilities?NoYesIf Yes, please state disabilitiesMedical Conditions?NoYesIf Yes, please state medical conditionsWhere did you hear about our activities?* Family Friend College Internet Previously attended OtherPhoto ConsentActivities may be recorded through photographs and video film both for the participant to collate and celebrate their experiences but also for evaluation and promotional purposes by C4C. I agree that the images may be used in media or publicity materials and celebration publications produced by those agencies. I understand that these images may be safely stored or archived digitally or manually and may be publicised in a variety of media forms including managed social network sites.Please tick one* I provide consent for such image(s) to be used at any time for promotional or publicity purposes I DO NOT provide consent for such image(s) to be used at any time for promotional or publicity purposesParent/Guardian ConsentFull name of Parent/Guardian*SignatureDate (dd/mm/yyyy)Submit