Concept Residency

February 12th to 16th 2018

Registration Form

What is ConceptResidency programme?

Concept is a music programme for young people aged 14 to 19 years. You will have the opportunity to make an album based on a concept or theme. You will be working with professional musicians and tutors to develop your own music and to learn a range of music and production skills. You will also have the opportunity to complete criteria from Bronze, Silver or Gold Arts Award.

When is the Concept residency?

The residency runs from Monday 12th February to Friday 16th February 2018

10a.m to 3pm

Where is the venue?The Core at Corby Cube, George St, Corby NN17 1QG

Celebration and Sharing:There will be a number of opportunities for participants to take part in. These include:

Concept Music Development Day: March 3rd 2018 at Corby Cube – Rehearse and refine your music and get one to one advice on your Arts Award portfolio.

Corby Mardi Gras: March 24th 2018

Emerge Festival: April 21st at Corby Cube

Please let us know if you are interested in attending these additional events

How do I get Involved?

Fill out the form below and return to

Questions?

If you have any remaining questions then do get in touch with us below.

Kate Rounding

Project Manager

Pedestrian

0116 251 6207

REGISTRATION FORM – FEBRUARY 12TH TO 16TH 2018

Participant Name:
Name of Carer/Guardian:
Address:
Town:
Post Code:
Tel:
Email:
Name of School/College/Organisation:
(If applicable) Name and contact details of Social Worker

PEDESTRIAN is committed to making our creative activities accessible to everyone. If you have any specific medical, physical, emotional, sensory, educational or learning difficulties, please make us aware of this, so we can best support you to take part with us. Do you have any additional needs we should be aware of?

Yes No (Please tick as appropriate)

If yes, please describe the support need and anything that we can do to help you to be fully involved.

Support needs and information / Please give as much information as you think is useful.
Medical Information / Please let us know if you will be bringing any medication with you and any details we may need to know. For example if you are bringing an inhaler with you.

We are required to monitor ethnic origin, gender and disability, and would be grateful if you would complete this form to enable us to do this. Please note the categories used are those recommended by the Equality and Human Rights Commission (EHRC).I would describe my ethnic origin as (Please tick in appropriate box):

(A)
White British / (A)
White Irish / (A)
White Other / (B)
White Black Caribbean / (B)
White Black African / (B)
White & Asian / (B)
Other Mixed / (C)
Asian or Asian British Indian
(C)
Asian or Asian British Pakistani / (C)
Asian or Asian British Bangladeshi / (C)
Asian or Asian British
Other / (D)
Black or Black British Caribbean / (D)
Black or Black British African / (D)
Black or Black British Other / (E)
Chinese / (E)
Other Ethnic Groups

EMERGENCY INFORMATION

These details are needed in case support is needed immediately - please give as much information as possible. For under 18’s this will usually be a parent, carer or guardian.

Emergency Contact 1 / Emergency Contact 2
Name: / Name:
Relationship to Participant: / Relationship to Participant:
Contact Number (s) : / Contact Number (s) :

Permissions & Consent (18 and Over can sign for themselves for Photo/video consent)

✓

I give permission for photographs, audio and video footage of the young person to be used for educational use only, as part of the Arts Award accreditation.

I give permission for photographs, audio and video footage of my child to be used for promotional or publicity purposes by Pedestrian and project partners.

I give permission for my child to leave the building unsupervised during lunchtime

I give permission for my child to leave the workshop building alone at the end of the session

(Please note that if you are not allowing your child to leave alone, a member of staff will stay with them until you pick them up. If applicable please state the collection arrangements for your child.)

I have read and understoodthis form and I agree to the named participant taking part.

I, the person with responsibility of …………………………………………………………………. agree to all the permissions that have been ticked above.

Print name...... Signed......

Relationship to Participant ...... Date...... /...... /......

PLEASE COMPLETE THE REGISTRATION FORM AND EMAIL TO