Teacher’s CPD Monitoring Form

Welcome to Rich Mix! Please fill out this form so that you’re able to take part in Pic ‘n’ Mix 22/23 and the Teacher’s CPD on Mon 26 Sep. We need your permission before we can photograph or make any recordings of you – these are important for us to reach audiences and communicate with funders so that we can continue to offer as many activities as possible. If you agree to give consent, please sign below. If you would like to be added to our mailing list please let us know below. Rich Mix will store and process your data as per our Privacy Policy, which can be found online at richmix.org.uk/privacy-policy. By giving your consent you are also consenting to us sharing relevant data and images with project partners Into Film, THAMES, Portal Trust, Derwent London & Canary Wharf Group. The health and wellbeing of our staff and visitors is our number one priority. Rich Mix is a COVID-secure venue. Please familiarise yourself with our safety measures before your visit richmix.org.uk/keeping-you-safe-during-coronavirus/

Name:
Address
Your age
Are you a Tower Hamlets resident or student?
Would you like to be added to our mailing list?
How do you describe your religion or belief?
How do you describe your gender

Choose one answer out of the following six sections that best describes your ethnicity.

Black, Black British or African
Asian or Asian British
White or White British
Mixed / Dual Heritage
Additional options

Thank you for completing this form.