Pupil Enrolment Monitoring: Pic n Mix

Hello from Rich Mix! Please fill out this form so that your child is able to take part in Pic ‘n’ Mix for 22/23. This is a year long programme where your child will learn about filmmaking, attend free cinema screenings and make their very own movie that will premiere on the big screen at Rich Mix’s cinema! We need your permission before we can photograph or make any recordings of your child – eg. if your child is to act in the film or appear in any behind the scenes photographs. These are important for us to reach audiences and communicate with funders so that we can continue to offer as many free 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 anonymous data and images with project partners, THAMES and Into Film.

Name of child date of birth, age and school:
Name
DOB
Age
School
 
Name of Parent/Guardian:
Address:
Emergency Contact Name:
Does your child have any SEND needs?
Tower Hamlets resident or student?
Do you consent to your child being filmed / photographed as part of the project?
Would you like to be added to our mailing list?

About Your Child

Religion or belief?
Gender?

Please choose one of the following options to describe your child's ethnicity.

Black, Black British or African
Asian or Asian British
White or White British
Mixed or dual heritage
Additional Options

Thank you for filling in this form.