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PARTICIPATION FORM: AFRICAN DANCE
Participation form for 'African Dance'. Thursdays at 1:30-2:30pm on Zoom.
Telephone: 07825287334
Email:
sibu@africancommunitycentre.org.uk
kwesi.idun@africancommunitycentre.org.uk
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* Indicates required question
Name
*
Your answer
Age range
*
16-24
25-34
35-44
45-54
55-64
65+
Contact details (email or other)
*
Your answer
Home address
*
Your answer
Home address location
*
Swansea - SA Postcode
Neath Port Talbot - SA1 Postcode
Cardiff - CF Postcode
Home postcode
*
Your answer
Gender
*
Male
Female
Non-binary
Transgender
Prefer to not say
Please select from the following
*
I do not have a disability
I have a long-term illness or health condition
I have a learning disability
I have a vision impairment
I have a physical disability
I have a mental health condition
My disability is not listed
Other:
If you have a disability not represented in the list provided, please enter further details below.
Your answer
How will you be attending the sessions?
*
Face-to-face
Zoom
Is there any other information that it would be useful for us to know to support your participation in the activity?
Your answer
Please indicate which ethnic group you feel best represents you.
*
African
Bangladeshi
Caribbean
Chinese
Gypsy/Traveller
Indian
Pakistani
White British (Welsh, English, Scottish, Ulster-Scots, Cornish)
White Irish
White European
Mixed - White and Black African
Mixed - White and Southern Asian
Other
Prefer to not say
If your ethnicity was not represented, please provide further details
Your answer
Are you currently a Refugee or Asylum Seeker?
*
Yes
No
Prefer to not say
Do you consent for photographs or other media related to the project being used by the ACC in the public domain?
*
I consent
I do not consent
I confirm that the information provided on this form is correct to the best of my knowledge.
*
I agree
Data Protection: The information provided by you will be held by the ACC in accordance with our Data Protection Policy. We may use this information to inform you about forthcoming sessions and events. If you wish to remove yourself from our database at anytime, please contact:
info@africancommunitycentre.org.uk
.
*
I agree and consent to be contacted about forthcoming sessions and events
I disagree I do not consent to be contacted about forthcoming sessions and events
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