Entr'acte Youth Company Membership Form 2023
To be completed by a Parent/Guardian if the applicant is under 18 years of age.
Member's Details
Full Name of Young Person
*
First Name
Last Name
Date of Birth (DD/MM/YYYY)
*
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Month
-
Day
Year
Date
Home Telephone Number
*
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Area Code
Phone Number
Mobile Telephone Number
*
-
Area Code
Phone Number
E-mail Address
*
Address
*
Address 1
Address 2
Town
County
Postcode
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Member's Medical Information
Name of GP
*
Name
Surgery Phone Number
*
-
Area Code
Phone Number
NHS Number
*
Number
Address
*
Address 1
Address 2
Town
County
Postcode
Medical History
*
Details of any regular medication, health conditions (e.g Asthma, epilepsy, diabetes, allergies, dietary needs etc.) or disability, which may affect normal activity. If none applicable, please type NONE
Date of Last Tetanus Injection
*
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Month
-
Day
Year
Date
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Parent/Guardian's Details (1)
Name of Parent
*
First Name
Last Name
Home Telephone Number
*
-
Area Code
Phone Number
Mobile Telephone Number
*
-
Area Code
Phone Number
E-mail Address
*
Address
*
Address 1
Address 2
Town
County
Postcode
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Parent/Guardian's Details (2)
Name of Parent
First Name
Last Name
Home Telephone Number
-
Area Code
Phone Number
Mobile Telephone Number
-
Area Code
Phone Number
E-mail Address
Address (if different from Parent 1)
Address 1
Address 2
Town
County
Postcode
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Additional Contact Information (Grandparent etc, or other person holding parental responsibility)
Name
First Name
Last Name
Home Telephone Number
-
Area Code
Phone Number
Mobile Telephone Number
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Area Code
Phone Number
Relationship to Member
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Permissions (1)
I give permission for the proposed member to take part in the normal activities of Entr’acte Youth Company.I understand that while involved, they will be under the control and care of the group leader/director and/or other adults, approved by the Entr’acte Company Board, and that while the staff in charge of the group will take all reasonable care of the young people, they cannot necessarily be held responsible for any loss, damage or injury suffered by the young person during, or as a result of, the activity.
*
I give permission and understand
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Permissions (2)
I understand that
1. Every effort will be made to contact me as soon as possible should my child become ill or have an accident. 2. My child may receive their own medication, administered according to guidelines issued with the medication, should the need arise; 3. My Child may be given medical/dental treatment as necessary.
*
I give permission and understand
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Permissions (3)
I have read, understood and signed the Photography, Filming, Publicity, Marketing and Data Storage Consent Form.
Yes
I have read and understood the following policies (which can be found via our website) and agree to the terms set out therein. Privacy Notice; Equality, Diversity and Equal Opportunities, Data Protection, Code of Conduct.
*
Yes
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Permissions (4)
I agree to be contacted in the following way(s) for the purposes of disseminating relevant information pertaining to the current projection/production. We will also send you information we deem relevant to you for the purposes of marketing current/future projects/productions. We WILL NOT sell your personal information to any 3rd parties. Please tick all that apply.
*
Telephone
Text
Email
Social Media
I understand that:Annual Membership is £250 (which is to be paid in full April of each year)Alternatively, members can pay £24 a month via standing order. All membership payments are non-refundable. I understand that all rehearsals and workshops will be included in the subscriptions and 1 full months notice will be required if I decide to cease attending Entr’acte Youth Company.
*
Yes
Once this form has been recieved, the company will be in touch via email with payment details.
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Signing of the membership form
Full Name
*
First Name
Last Name
Status of person completing the form
*
Date
*
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Month
-
Day
Year
Date
Signature
*
Submit
Submit
Should be Empty: