SPID Theatre Company

1. Participant’s First Name

2. Participant’s Last Name

3. Participant DOB

4. Participant’s postcode

5. Email Address *

6. Will you be over 18 on the 12th August 2021

7. Phone Number, SKIP TO Q9

8a. Parents Name

8b. Contact number of Parent, continue onto Q9

9. Emergency Contact Number

10 What is your relation to the emergency contact?

11. Preferred Name or Nickname

12. Preferred pronouns

13.Any medical information/anything we should know

14. Any thing else, you would like us to know?

15. Are you in…

16. How did you hear about us?

Tick box if additional needs should be discussed

18. Do you live on an estate

19. Do you have experience of…

20. Photo Audio & video consent: please tick

I hereby give my consent for SPID to use photographs, audio or video recordings in which I appear. I
I understand that SPID Theatre Company will take photographs and carry out sound and video recording
I do not give consent for SPID Theatre to use my images, audio or video recordings.
I do not consent and I am aware that I will need to turn off my camera during SPID online sessions.

Youth Workshops Signup Form