Child's First Name

Child's Surname

Email (All correspondence will be sent here)

Telephone Number

Address

Post Code

Age

Date of Birth

Estimated Height

Dance/Drama School

Local Education Authority (related to where you live)

Emergency Contact Number (Different from above)

Dates of rehearsals or performances you would be unable to attend

Parent/Guardian Name

I (parent/guardian) am a registered chaperone I (parent/guardian) am a registered chaperone Yes No

I (parent/guardian) am a willing to apply to become a registered chaperone I (parent/guardian) am a willing to apply to become a registered chaperone Yes No

Data Protection Consent Data Protection Consent I confirm that I have read and accept the Upstage Productions Privacy Policy and that the personal information I have provided may be kept and used by Upstage Productions under the terms of that policy.