Volunteer with us…

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Daytime Contact Number *

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Name of Emergency Contact *

First Name

Last Name

Emergency Contact Number *

(###)

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Name of 2nd Emergency Contact *

First Name

Last Name

2nd Emergency Contact Number *

(###)

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Photo/Video Consent Our workshops and performances may be filmed or photographed for evidencing our work, fundraising, publicity or promotional purposes. This might include (but is not limited to) printed and online publicising, social media, reports and funding applications. Please indicate below whether you do or do not give permission for you or the applicant to be filmed and/or photographed.

I give permission for you or the applicant to be filmed and/or photographed.

I do not give permission for you or the applicant. to be filmed and/or photographed.