Serman Inc. Youth Theatre

Autumn Term 2016 Re-enrolment

Hello All,

We are very much looking forward to launching our Autumn term of activity. Our new groups offer a more focused and creative activity for our participants.

The Autumn Term Dates are:

First week of term: W/C Monday 19 September 2016
Half Term (No sessions): W/C Monday 24 October 2016
Last week of term: W/C Monday 28 November 2016

Please use this survey to enrol yourself and/or your young people onto the appropriate group or groups for our Autumn Term. To avoid any disruption for our participants, we are now placing young people into groups according to their school years. They will remain in these groups for the duration of our year's activity.

The deadline for re-enrolment is Monday 5 September. After this date any remaining places will be made available to those on our waiting list.

All information submitted is confidential.

With thanks,

The Sherman Team

Question Title

* 1. Contact Information

Your Name

Participant's Name if different

Address 1

Address 2

City/Town

County

Postal Code

Country

Email Address

Phone Number

Question Title

* 2. Participant's Details

Participant's Age

Participant's Date of Birth

Participant's School Year

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* 3. Gender of Participant

Male

Female

Other

Prefer not to say

Question Title

* 4. Does the participant have any access requirements, medical conditions and/or allergies that we need to be aware of?

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* 5. Emergency Contact Details

Emergency Contact Name

Emergency Contact Telephone Number

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* 6. Ethnic Origin of Particpant

White Welsh/English/Scottish/Northern Irish

White Irish

White Gypsy or Irish Traveller

Any other White background

Black-Carribean

Mixed White and Black Caribbean

Mixed White and Black African

Mixed White and Asian

Any other Mixed/Multiple Ethnic background

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian Background

African

Caribbean

Any other Black/African/Caribbean background

Arab

Any other ethnic group