Young Actors FORM

Young Actors Application Form
The workshops:

Weekly creative workshops focusing on drama, acting, directing, theatre making and performing in a safe and fun environment for young people age 11-17.

No drama experience necessary.

You must commit to at least 1 term of workshops. This is not a drop in project, as you will be working towards performances.

Mondays 6.00-7.30pm @ Grand Junction, St Mary Magdalene’s Church, Rowington Close, W2 5TF.

All our facilitators are DBS checked and have lots of experience delivering youth programmes.

If you have questions or would like any further information please email joanne@grandjunction.org.uk or text on 07515 197 492
Child/participant details
Name*

First NameLast Name
Age and DOB*
Ethnicity*

WhiteAsian/ Asian BritishArabicBlack/ Black BritishMultiple ethnic groupsOtherPrefer not to say
I want to sign up a sibling: Name

First NameLast Name
Age and DOB
Child's school
Parent/carer details
Name*

First NameLast Name
Parent/ Carer Phone Number*
07989912345
E-mail*
example@example.com
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact 1 (we will only contact this person if we cannot get hold of the main parent contact in an emergency)*

Name

Number

Relationship to childState / Province

Postal / Zip Code
Emergency Contact 2 (we will only contact this person if we cannot get hold of the main parent contact in an emergency)*

Name

Number

Relationship to childState / Province

Postal / Zip Code
Does your child require any additional support you feel would be helpful for us to know so we can support your child in the most appropriate way? If so, please give details.*
Does your child have any medical or mobility issues? If so, please give details.*
How did you hear about us?*
Are you happy for your child to be photographed for future promotion on Grand Junction's website and social media?*

YesNo
Do you want you email added to our mailing list?*

YesNo
Tick if you give permission for your child to go home by themselves*

My child can leave by themselvesMy child cannot leave by themsleves
If you want someone other than you to pick up your child, please enter the name of the adult collecting them, and relationship to child*
Tick box to confirm that your child will attend all sessions*

My child will attend all sessionsMy child will not attend all sessions
Parent/carer Signature*

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Young Actors Application Form

Child/participant details

Parent/carer details