Home Ed Groups Application Form

Home Ed Groups: Lowther Pavilion Theatre

Thank you for your interest in our drama / creative sessions for Home Ed groups. This is a chance to work with others, build confidence, learn new skills, make friends and be creative. All sessions are at Lowther Pavilion Theatre, West Beach, Lytham St Annes FY8 5QQ. Please pay £5 per week, cash or card once you arrive. Wear comfortable clothing, soft shoes and bring a bottle of water if you are doing practical drama sessions. Please would a parent/carer fill out the form below on behalf of the child/young person and select the relevant group from the drop-down menu. We will not share your data with any external agencies. We look forward to working with you! If you have any questions, please contact: youththeatre@lowtherpavilion.co.uk
Child / Young Person's Name

First NameMiddle NameLast Name
Child / Young Person's Birth Date

MonthDayYear
Child / Young Person's Ethnicity - please select from the menu
Which group would they like to attend?
Age groups are flexible. Contact us to discuss.
Pronouns of child/young person

He/HimShe/HerThey/Them
Address of Child / Young Person

Street Address

Street Address Line 2

CityCounty

Postal Code
Name of Parent / Carer

First NameLast Name
Parent / Carer E-mail
example@example.com
Parent / Carer Telephone Number

Area CodePhone Number
Please inform us of any medical or other support needed and ensure that medication (if required) is with them during the sessions.
Photo/ Video Release Form. During sessions, images may be captured by video, photo and digital camera for the purposes of promotional materials and publication. I hereby give permission for images of the above named child / young person to be used for these purposes and waive any rights of compensation or ownership thereto.

I consentI do not consent
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Home Ed Groups: Lowther Pavilion Theatre