Filming Day- Hackney Young People Lecture Series

Name*
Surname*
In the last 14 days have you had a high temperature?*
In the last 14 days have you had any of the following symptoms: a new, continuous cough or a loss of, or change to, your sense of smell or taste?*
In the last 14 days have you tested positive for COVID-19?*
In the last 14 days have you been contacted by the NHS test and trace services and asked to self-isolate?*
In the last 14 days have you been contacted by the NHS test and trace services and asked to self-isolate?*
In the last 14 days have you been self-isolating after returning or entering the UK?*
In the last 14 days has anyone in your household or your close contacts had (or does anyone currently have): a high temperature, a new continuous cough or a loss of, or change to, their sense of taste or smell?*
In the last 14 days has anyone in your household or your close contacts tested positive for COVID-19?*
Photography, Video and Audio Consent*
To be photographed and filmed during the Summer School Programme. I agree to the photographs and video footage being used by Clarion Futures, AccessHE and HEI institutions ( Ravensbourne, Middlesex and LSE) in any of their publicity materials including: websites, press releases, promotional brochures, DVDs, posters, and newsletters. The photographs that are taken will remain the property of AccessHE. Any images used for publicity will not identify you by name.