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Registration Form Personal Details of Participant First Name: __________________________ Surname: _________________ Date of Birth _____________ Address: ____________________________________________________________________________ ___________________________________________________________ Home Tel _________________________
Postcode: ________________
Email _____________________________________________
(If applicable) Mobile ________________________School/College ______________________________ Learning Difficulties/Disabilities/Health Do you consider yourself to have a disability, health problem or learning difficulty? Please supply details.
Yes/No ________
Emergency Contact Parent/Guardian Name _______________________________ Relation to participant ________________ Contact Number___________________________
Contact Mobile Number _______________________
Please ensure this number is different from that supplied within Personal Details.
Data Protection Are you happy to be contacted by the following means:
POST Yes / No PHONE Yes / No
EMAIL Yes / No TEXT Yes / No
Please note your information will be held on file in accordance with our Data Protection Policy, see Terms and Conditions
Consent (to be completed Parent/Carer if applicant is under 16 years of age) I consent to the above named person receiving medical emergency treatment if necessary Yes / No I consent to the above named person being photographed/filmed where appropriate by NTR for general press/publicity purposes.
Yes / No
I consent to the above named person being photographed/filmed where appropriate by NTR for use on social media.
Yes / No
I consent to the above named person leaving sessions unaccompanied
Yes / No
Course applied for (please tick)
JUNIOR ARTS COURSE (Saturday age 7-15) YOUTH THEATRE COMPANY (16+) ADULT DRAMA WORKSHOP (18+)
EXAM CLASSES (Weekdays age 9-18) AUDITION TECHNIQUE (16+) ACCESS TO MUSIC (16+)
Participant Consent (to be completed by Parent/Carer if applicant is under 16 years of age) I wish to take part in NTR activities, I understand that I am responsible for my belongings whilst participating in NTR activities, and agree to the enclosed terms and conditions.
Signed ___________________________ Date __________________ Office Use: Received
Paid
Age
Group
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