Spotlight Membership Form

First name

Last name

Address 1

Postcode

Email address

Phone number

Please let us know how you'd like to be contacted?

By post

By email

By mobile

By text message

Other information

Young Person's Membership Form

-ALL- below information must be filled upon registration

Date of Birth

Parent / Guardian

First Name of Parent / Guardian

Last Name of Parent / Guardian

Parent / Guardian telephone number

Where did you hear about Spotlight?

Your Interests

Interests

Music

Visual arts

Film

Radio

Volunteering

Sports

Employability skills

Theatre

Dance

Fashion

Other Interests

Are you in education or training?

If you are in education which school do you go to?

Please tell us about yourself

Gender

Ethnicity

If other ethnicity, please specify

Do you consider yourself to have a disability

What type of disability do you have?

Special arrangements or support needed to help you take part

What is the name of your youth worker?

First Name of your Youth Worker

Last name of your youth worker

Consent

Membership Consent

I give permission for Spotlight to collect and securely store and use information, photos and film footage of me and use it to promote Spotlight and its partners work

I understand that information may be shared with partner organisations to support me and the services I access

I agree to Spotlight communicating with me by email, phone, text and post

I confirm that all the information provided in my membership form is true and correct

Signature

Signature (Please type your full name)

If you do not want photos or videos of you to be shared on social media, website or on materials to promote Spotlight please email hello@wearespotlight.com

Young Person Membership Form DATA CONSENT SIGNATURE

Date Consent received

Spotlight and Poplar HARCA is committed to protecting your personal information. The information collected above will be used to provide services to you. We will never pass your sensitive personal data onto a third party, unless we have obtained your consent or when legally required to do so. All information collected will be stored on our internal database for monitoring and service provision purposes. By submitting this form, you are agreeing to Poplar HARCA using your information as outlined here.

You can read our privacy policy here