Young Carers Drama Project Sign-up - Mercury Theatre Colchester

Young Carers Drama Project

For 8-15 year olds

Name of person filling in this form(Required)

First Last

Phone Number(Required)

Email(Required)

Name of Child(Required)

First Last

Age of Child(Required)

Date of Birth(Required)

Gender(Required)

Ethnicity (if happy to share)

Prefer to self-describe? Please let us know below

Child's Full Address(Required)

Do you allow for the young person to attend/leave sessions on their own?(Required)

Yes

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:

Access needs of the child (please be specific as possible to allow us to make this as successful as possible)

Any additional information we should be aware of?

First Aid Consent(Required)

Hospital Consent(Required)

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)