Tale Be Told Youth Theatre Registration Form

Access Support - Family Bonds

Sessions to support you and your family
Parent/Carer Name:*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Mobile Number:*
Email:*
example@example.com
Post Code:*
Ethnicity:*
Do you have any additional needs or medical conditions that we should be aware of?*
Do you have any allergies?*
How did you hear about this programme? (Mental Health services, GP, Social prescribers, social media, organisation, self-referral etc)*
Child/Children's Information
Name/names*
Age/ages:*
Do they have any additional needs or medical conditions that we should be aware of?*
Do they have any allergies?*
Which school/s does your child/children attend?
Acknowledgment
*Tale Be Told Theatre C.I.C is the data controller for this project. All data received is subject to a duty of confidentiality. Statistical date will be shared where appropriate with the NHS, this is not considered personal data as you cannot be identified by it. This sharing of data allows for the evaluation of our services and the impact of it. All data will be appropriately deleted once the programme is complete.

Contact Kulraj on kulraj@talebetold.co.uk or 07497 853323 If you have any questions.

I have answered all of the questions correctly and I understand the clear boundaries set out in this document.
Signature

Clear
Date Signed

DayMonthYear
Date
Thank you for taking the time to fill out this document. We look forward to having you joining our programme.
© Tale Be Told Theatre C.I.C.

Tale Be Told Theatre is a Community Interest Company, Registered in England, limited by guarantee. Company Number: 10439178
Should be Empty:

Access Support - Family Bonds

Child/Children's Information

Acknowledgment