The Script Room Registration Form Registration Details Question Title * 1. Young Person's Full Name OK Question Title * 2. Date of birth Date Date OK Question Title * 3. Address OK Question Title * 4. Town OK Question Title * 5. Postcode OK Question Title * 6. School Attended OK Question Title * 7. School Year Group OK Question Title * 8. Parent/Guardian's Full Name OK Question Title * 9. Relationship to Young Person OK Question Title * 10. Home Tel Number OK Question Title * 11. Mobile Tel Number OK Question Title * 12. Email address OK Question Title * 13. Alternative Emergency Contact Name (this person will be contacted if we cannot get hold of the above in an emergency) OK Question Title * 14. Relationship to Young Person OK Question Title * 15. Tel Number OK Question Title * 16. Please select which sessions you would like your young person to attend (please ensure they are attending the right session for their age) Group 1 (Age 8-11) - 3-3.45pm Group 2 (Age 12-16) - 4-4.45pm Group 3 (Age 16-21) - 5-5.45pm Tuesday 28 April 2020 Yes Tuesday 28 April 2020 Group 1 (Age 8-11) - 3-3.45pm menu Yes Tuesday 28 April 2020 Group 2 (Age 12-16) - 4-4.45pm menu Yes Tuesday 28 April 2020 Group 3 (Age 16-21) - 5-5.45pm menu Tuesday 12 May 2020 Yes Tuesday 12 May 2020 Group 1 (Age 8-11) - 3-3.45pm menu Yes Tuesday 12 May 2020 Group 2 (Age 12-16) - 4-4.45pm menu Yes Tuesday 12 May 2020 Group 3 (Age 16-21) - 5-5.45pm menu Tuesday 26 May 2020 Yes Tuesday 26 May 2020 Group 1 (Age 8-11) - 3-3.45pm menu Yes Tuesday 26 May 2020 Group 2 (Age 12-16) - 4-4.45pm menu Yes Tuesday 26 May 2020 Group 3 (Age 16-21) - 5-5.45pm menu Tuesday 9 June 2020 Yes Tuesday 9 June 2020 Group 1 (Age 8-11) - 3-3.45pm menu Yes Tuesday 9 June 2020 Group 2 (Age 12-16) - 4-4.45pm menu Yes Tuesday 9 June 2020 Group 3 (Age 16-21) - 5-5.45pm menu OK Question Title * 17. Are there any access needs we may need to be aware of? (e.g. mobility) OK Question Title * 18. Is there anything we can do to support the young person's participation? OK Question Title * 19. Are there any medical conditions we may need to be aware of? (e.g. allergies, any regular medication taken) OK Question Title * 20. Email address the Zoom link should be sent to OK Question Title * 21. Name of the Zoom account holder (name appearing on screen) OK Question Title * 22. Please tick the boxes if you consent to the following: Permission for your young person to take part in facilitated Youth Arts activity on the digital platforms Permission to produce recordings during Youth Arts activity for Wiltshire Creative marketing including online and social media Permission to contact you regarding various activities and opportunities for your Young Person including specialist workshops, auditions and ticket discounts OK Question Title * 23. You acknowledge that it is the parent/guardian's responsibility to update Wiltshire Creative with any change in contact details Yes OK Question Title * 24. You confirm that you have read the guidance available on the relevant page of the Wiltshire Creative website. Click here to read the document. Yes OK Question Title * 25. Signed (a typed name will be acceptable in this instance) OK Question Title * 26. Date Date Date OK Payment - This activity is free at this time but you may make a donation through our website if you wish by clicking here. OK NEXT
