18+ Norwich Theatre Take Part Registration Form

Registration Details

Please only complete this form once you have booked onto a course or activity with our Box Office team.

If you have not booked directly with us please visit our website: norwichtheatre.org/take-part

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* 1. Which Workshop/Course/Class are you booked on?

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* 2. Your Contact Details

First Name

Surname

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* 3. Your Date of Birth

DD/MM/YYYY

Date

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* 4. Your Address Details

Name

Address

Address 2

City/Town

Postcode

Email Address

Telephone No

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* 5. Emergency Contact Details

First Name

Surname

Email Address

Telephone No

Relation to you

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* 6. Are there any access, medical problems (allergies, any regular medication taken) we need to be aware of? Family or other information can be discussed with the team directly or entered in the box below as well.

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* 7. Consent & Agreement (Ticked boxes will assume consent)

You give us permission to administer First Aid in a medical emergency

You give us permission to produce recordings including taking photographs during a Norwich Theatre Course/Class/Workshop for marketing purposes to be used across our website, social media, press and print

You have read the terms & conditions outlined on the the course page on the website or via www.norwichtheatre.org/take-part/participant-information/

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* 8. Marketing Communications Preferences - You give us permission to contact you regarding various activities and opportunities including specialist workshops, auditions and ticket discounts across the Norwich Theatre stages (Un-ticked boxes will assume no consent for marketing communications)

Post

Your Wellbeing
All wellbeing answers will be recorded anonymously

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* 9. How would you rate your wellbeing over the last two weeks?
(1 is very poor and 10 is excellent)

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 10. Below are some statements about feelings and thoughts. Please tick the box that best describes your experience of each over the last two weeks.

	None of the time	Rarely	Some of the time	Often	All the time
I’ve been feeling optimistic about the future	I’ve been feeling optimistic about the future None of the time	I’ve been feeling optimistic about the future Rarely	I’ve been feeling optimistic about the future Some of the time	I’ve been feeling optimistic about the future Often	I’ve been feeling optimistic about the future All the time
I’ve been feeling useful	I’ve been feeling useful None of the time	I’ve been feeling useful Rarely	I’ve been feeling useful Some of the time	I’ve been feeling useful Often	I’ve been feeling useful All the time
I’ve been feeling relaxed	I’ve been feeling relaxed None of the time	I’ve been feeling relaxed Rarely	I’ve been feeling relaxed Some of the time	I’ve been feeling relaxed Often	I’ve been feeling relaxed All the time
I’ve been dealing with problems well	I’ve been dealing with problems well None of the time	I’ve been dealing with problems well Rarely	I’ve been dealing with problems well Some of the time	I’ve been dealing with problems well Often	I’ve been dealing with problems well All the time
I’ve been thinking clearly	I’ve been thinking clearly None of the time	I’ve been thinking clearly Rarely	I’ve been thinking clearly Some of the time	I’ve been thinking clearly Often	I’ve been thinking clearly All the time
I’ve been feeling close to other people	I’ve been feeling close to other people None of the time	I’ve been feeling close to other people Rarely	I’ve been feeling close to other people Some of the time	I’ve been feeling close to other people Often	I’ve been feeling close to other people All the time
I’ve been able to make up my own mind about things	I’ve been able to make up my own mind about things None of the time	I’ve been able to make up my own mind about things Rarely	I’ve been able to make up my own mind about things Some of the time	I’ve been able to make up my own mind about things Often	I’ve been able to make up my own mind about things All the time

Virtual Creative Activity Participation Agreement
Please ensure you have read the online procedures and participation documents we have emailed you.

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* 11. Over 18 years old Online Participation

I agree to take part in Norwich Theatre online virtual activities

I understand that Norwich Theatre will keep a record of the activity for safeguarding reasons - this may include recording the session

I understand that I need to follow the code of conduct and any safety rules so that Norwich Theatre can keep everybody safe

18+ Norwich Theatre Take Part Registration Form

Registration Details

Question Title

* 1. Which Workshop/Course/Class are you booked on?

Question Title

* 2. Your Contact Details

Question Title

* 3. Your Date of Birth

Question Title

* 4. Your Address Details

Question Title

* 5. Emergency Contact Details

Question Title

* 6. Are there any access, medical problems (allergies, any regular medication taken) we need to be aware of? Family or other information can be discussed with the team directly or entered in the box below as well.

Question Title

* 7. Consent & Agreement (Ticked boxes will assume consent)

Question Title

* 8. Marketing Communications Preferences - You give us permission to contact you regarding various activities and opportunities including specialist workshops, auditions and ticket discounts across the Norwich Theatre stages (Un-ticked boxes will assume no consent for marketing communications)

Question Title

* 9. How would you rate your wellbeing over the last two weeks?(1 is very poor and 10 is excellent)

Question Title

* 10. Below are some statements about feelings and thoughts. Please tick the box that best describes your experience of each over the last two weeks.

Question Title

* 11. Over 18 years old Online Participation

* 9. How would you rate your wellbeing over the last two weeks?
(1 is very poor and 10 is excellent)