So You Want To Work in Theatre - Funded Place

So You Want To Work In Theatre – Funded Place

Name of person filling in this form(Required)

First Last

Phone Number(Required)

Email(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

They are ‘looked-after children’ or previously ‘looked after children’

Child with an EHC plan (education, health and care)

My household is low income

The majority of spaces are for children who recieve Free School Meals. However, we do have limited spaces available for other reasons.

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)

Tuesday – Lunch Options(Required)

Please choose your childs lunch options Tuesday. Please confirm with the child what they would prefer as we won’t be able to make changes on the day.

Wednesday – Lunch Options(Required)

Please choose your childs lunch options for Wednesday. Please confirm with the child what they would prefer as we won’t be able to make changes on the day.

Thursday – Lunch Options(Required)

Please choose your childs lunch options for Thursday. Please confirm with the child what they would prefer as we won’t be able to make changes on the day.

Do you give you child permission to leave the theatre at the end of the day and make their own way home(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)

(Including any injuries as they will be doing physical activity)

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)

So You Want To Work in Theatre – Funded Place

So You Want To Work In Theatre – Funded Place