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Registration Form

Sessions take place in the Community Room at Salisbury Playhouse.

Tuesday 14th March, 4:30-6:30pm
Tuesday 21st March, 4:30-6:30pm

You must fill out this registration form before attending your first session. If under 18, it should be completed by a parent/guardian.

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* 1. Young Person's Full Name 

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* 2. Date of birth of young person

Date

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* 3. Address

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* 4. Postcode

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* 5. School/college Attended if applicable

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* 6. Email Address

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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. Alternative Emergency Contact Name (this person will be contacted if we cannot get hold of the above in an emergency and will need to be able to collect the young person if necessary)

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* 12. Relationship to Young Person

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* 13. Tel Number

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* 14. Are there any access needs we may need to be aware of? (e.g. mobility)

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* 15. Are there any medical conditions we may need to be aware of? (e.g. allergies, any regular medication taken, mental health considerations)

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* 16. Is there anything we can do to support the young person's participation?

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* 17. Is the young person a young carer?

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* 18. Please tick the boxes if you DO consent to the following:

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