Registration details

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* 1. Young Person's Full Name (as it should appear in a programme)

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* 2. Date of birth

Date / Time

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* 3. Address

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* 4. Town

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* 5. Postcode

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* 6. School Attended

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* 7. Parent/Guardian's Full Name

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* 8. Relationship to Young Person

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* 9. Home Tel Number

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* 10. Mobile Tel Number

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* 11. Email address

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* 12. Alternative Emergency Contact Name (this person will be contacted if we cannot get hold of the above in an emergency)

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* 13. Relationship to Young Person

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* 14. Tel Number

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* 15. Please select which group you'd like to join

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* 16. Are there any access needs we may need to be aware of? (e.g. mobility)

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* 17. Is there anything we can do to support the young person's participation?

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* 18. Are there any medical conditions we may need to be aware of? (e.g. allergies, any regular medication taken)

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* 19. Please tick the boxes if you DO NOT consent to the following:

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* 20. You acknowledge that it is the parent/guardian's responsibility to update Wiltshire Creative with any change in contact details

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* 21. Payment

Thank you for completing the Stage 65 Youth Theatre registration form. 

The Take Part team will be in contact with you shortly.
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