Stage 65 Youth Theatre registration form

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

Date

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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

Mondays, Group 3 (year 6 & 7), 4.30pm - 5.30pm
Salisbury Playhouse

Mondays, Group 4 (year 8 & 9), 5.45pm - 7.15pm
Salisbury Playhouse

Mondays, Young Company (year 12+), 7.30pm - 9pm
Salisbury Playhouse

Tuesdays, Group 2 (year 4 & 5), 4.30 - 5.30pm
Salisbury Playhouse

Tuesdays, Group 5 (year 10 & 11), 5.45pm - 7.15pm
Salisbury Playhouse

Tuesdays, Young Company (year 12+), 7.30pm - 9pm
Salisbury Playhouse

Wednesdays, Group 3 (year 6 & 7), 4.30pm - 5.30pm
Salisbury Playhouse

Wednesdays, Group 4 (year 8 & 9), 5.45pm - 7.15pm
Salisbury Playhouse

Wednesdays, Group 5 (year 10 & 11), 7.30pm - 9pm
Salisbury Playhouse

Saturdays, Group 1A (reception and year 1), 10am - 11am
Salisbury Playhouse

Saturdays, Group 1B (year 2 and 3), 11.15am - 12.15pm
Salisbury Playhouse

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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:

You give us permission to administer First Aid

You give us permission to produce recordings including photographs during Stage 65 activity for Wiltshire Creative marketing including online and social media

You give permission for limited physical contact with fellow participants and project leaders which can be involved in Stage 65 activity

You give us permission to contact you regarding various activities and opportunities for the Young Person including specialist workshops, auditions and ticket discounts

You give permission for the Young Person (16 and over only) to leave unaccompanied at the end of the session

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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

Yes

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* 21. Payment

I will paying a full term fee of £67

I will be applying for a reduced fee of £47 (for families on low income - £11,000 for a single parent family / £15,000 for a family with two resident parents/carers)

I will be applying for a bursary and a reduced fee of £27 (for families in receipt of means tested benefits)

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

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