Digital Summer School - Funded Place - Mercury Theatre Colchester

Name of person filling in this form(Required)

First Last

Phone Number(Required)

Email(Required)

Is your child in Primary or Secondary school?(Required)

What School does the child attend?(Required)

I can confirm, I an eligible for a free space on the Essex ActivAte programme because:(Required)

My child receives free school meals

We are now only able to offer places to children who recieve Free School Meals due to our funding provision and requirements.

Primary School Children – What is your Wonde eVoucher Code?

Primary School Children – If your child is eligible for benefit based free school meals you will be given, or can obtain from your school, a Wonde eVoucher code that will enable you to book onto one of the funded places at an Essex ActivAte Club free of charge. Please note that wonde codes / e vouchers were sent out to all primary & Junior schools, so parents booking will be able to enter the 16 digit number. If you feel you are eligible but dont have a Wonde code, please write this in the box and someone will be in touch.

Have you been to an ActivAte club before?(Required)

If yes, please tell us what club/clubs?

Name of Child(Required)

First Last

Age of Child(Required)

Date of Birth

Gender(Required)

Ethnicity (if happy to share)

Prefer to self-describe? Please let us know below

Child's Full Address(Required)

What lunch option would your child prefer?(Required)

Does your child prefer to eat…(Required)

Others authorised to pick up the child (name and number)

In the event of an emergency please provide full details of a second contact.(Required)

This is in case we are unable to contact the parent or guardian. (please include, name, contact telephone number and relationship to participant)

Is there any medical information we should be aware of?(Required)

If you answered yes above, please detail below:

Is the participant allergic to anything (e.g. antibiotics, elastoplast, aspirin or any other medicines, any particular food, etc.)?

Does the child have any access needs? If yes. please answer below.

Any additional information we should be aware of?

Have you been to the Mercury Theatre before?

Yes – to watch a show

Yes – to take part in a workshop or other creative engagement activities

Do you give us permission to photograph your child and use on the Mercury's social media and advertisements?(Required)

Digital Summer School – Funded Place