U17 Norwich Theatre Take Part Registration Form

Registration Details

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* 1. Which Workshop/Course/Class would you like to join?

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* 2. Participants Full Name

First Name

Surname

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* 3. Participant's Date of Birth

DD/MM/YYYY

Date

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* 4. Participant Address Details

Name

Address

Address 2

City/Town

Postcode

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* 5. Parent/Guardian Full Name

First Name

Surname

Relation to Participant

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* 6. Parent/Guardian Contact Details

Email Address

Telephone No

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* 7. Parent/Guardian Address Details (ignore if the same as participant)

Address

Address 2

City/Town

Postcode

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

First Name

Surname

Email Address

Telephone No (the contact number must be different from the number given above)

Relation to participant

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* 9. 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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* 10. 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 Stage Two Course/Class/Workshop for marketing purposes to be used across our website, social media, press and print

You give permission for the participant to leave unaccompanied at the end of the session

You give permission for the named participant to take part in relevant course/class/workshop activities and 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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* 11. Marketing Communications Preferences - You give us permission to contact you regarding various activities and opportunities for the participant including specialist workshops, auditions and ticket discounts across the Norwich Theatre stages (Un-ticked boxes will assume no consent for marketing communications)

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