The Children and Young Person Acts 1933 and 1963 The Children (Performances and Activities) (England) Regulations 2014 )

The Children and Young Person Acts 1933 and 1963 The Children (Performances and Activities) (England) Regulations 2014 )
Standard Child Performance & Activities Licence Application Form (England) Note: this form should be completed and submitted to the licensing authority not less than 21 days before the first performance or activity for which the licence is requested, since the licensing authority may otherwise refuse to grant a licence.

Part 1: Information to be provided by the applicant about the performance or activities1

Coronavirus - we would expect all production companies to be observing government guidance and the agreed industry standards and to document how they plan to do this as part of the application process.
Title
Name
Job Title
Company
Address
Tel
Mobile
Email
1)Does your organisation have a child protection or safeguarding policy? Please insert a link or attach a copy.
Yes, sent separatelyIf you do not have a policy, please use the template on our website
b) When was this last updated?

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must be within 12 months, use today's date if using our template
Note: it is best practice that organisations that involve children in performances, paid modelling or paid sport have or develop a child protection policy, regularly review and update it, and ensure that all staff and volunteers are familiar with it.
2)Name and nature of the performances or activities in respect of which the licence is requested:
3)Please provide as full a description as you can about what the child will actually be required to do. Include information about the environment they will be asked to do it in, and any other contextual information that may help us in assessing the potential risks, physical, emotional or psychological, to the child.
4) If you have completed a risk assessment please attach it to this application. See the sector led best practice guidance for further information about risk assessments.

4) (a) Please provide a completed risk assessment setting out how your organisation will manage the risks associated with Coronavirus (Covid-19) (in accordance with current Government and Health and Safety Executive

Guidance) for the child performer for all places of performances and rehearsal, for which the licence is requested, including any on location.
5)Place of activities, performances and rehearsal for which the licence is requested, including any periods on location:
6)The dates and times of activities, performances or rehearsals for which the licence is requested: If the dates are not known at this time, please provide the number of days and the period during which it is requested that a child may take part in activities, performances or rehearsals.
7)The expected total running time or duration of activities or performances (including any rehearsal) in respect of which a licence is requested:
8)The approximate duration of the child’s appearance in the performance or activity:
9)The amount of night work (if any) for which approval is being sought and please state:
a) the approximate number of days:
usually N/A if nightworking is not required
b) the approximate duration on each day:
usually N/A if nightworking is not required
c) the reason that the performance must take the form of night work:
usually N/A if nightworking is not required
10) a) The sums to be earned by the child in taking part in the performance or activity:
b) The name, address and description of the person to whom or to which the sums are to be paid (if not to the child in question):
The childs agent- Pixie Child Models Ltd 8 Flitcroft St London WC2H 8DL
11)Where a licence is requested in respect of a performance, the proposed arrangements for any rehearsals prior to the first performance for which a licence is requested. For each rehearsal please state the date, the place, and the approximate time and duration:
usually N/A if rehearsals are not required
12)The days or half days on which leave of absence from school is requested to enable the child to take part in the performance, rehearsals or activity:
Entre Zero if the child is below school age or the production is at the weekend or during a school holiday
13)Proposed arrangements (if any) for the education of the child during the period for which the licence is requested stating -
a) Where the education is to be provided by a school, name and address of the school:
usually N/A
b) Where the education is to be provided other than by a school: i. name, address and qualification of the proposed teacher;
usually N/A
ii. the place where the child will be taught;
usually N/A
iii. the proposed course of study;
usually N/A
iv. the number of other children to be taught at the same time by the same teacher and the sex and age of each child;
usually N/A
v. whether the child is to receive the amount of education in accordance with regulation 13(3)(e) of the Children (Performances and Activities) (England) Regulations 2014
usually N/A
14)The name and address of the proposed chaperone, or the name and address of the parent or teacher who will have care of the child:
The Parent- see child's home address and parents details on section 2
15)The name of the local authority or (in Scotland) the education authority (if any) which has previously approved the appointment of the chaperone:
usually N/A
16)The number of children to be in the charge of the chaperone during the time when the chaperone will be in charge of the child and the sex and age of each child:
usually N/A
17)The address of any accommodation where the child will live, if different from the place where the child would ordinarily live, the number of other children and details of the chaperone (if any) who will live in the same accommodation:
usually N/A
18) a) Approximate length of time which the child will spend travelling to and from the place of performance, rehearsal or activity each day:
Under an hour
b) Arrangements (if any) for transport there:
None- will be travelling with parent by car
c) Arrangements (if any) for transport back:
None- will be travelling with parent by car
19)The name of any other local authority, or in Scotland, any education authority to which an application has been made for another child to take part in performances or activities to which the application relates (if not known at the time of application, to be provided when known):
Note: this will help the relevant local authorities to take a consistent approach
I certify that to the best of my knowledge the details in this application are correct. I hereby apply for a licence under section 37 of the Children and Young Persons Act 1963:
Signature of applicant: (To be signed by person named on page 1)

Clear
Date:

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