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Registration Details

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* 1. Young Person's Full Name

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* 2. Date of birth

Date

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* 3. Address

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* 4. Town

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* 5. Postcode

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* 6. School Attended

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* 7. School Year Group

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* 8. Parent/Guardian's Full Name

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* 9. Relationship to Young Person

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* 10. Home Tel Number

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* 11. Mobile Tel Number

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* 12. Email address

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* 13. Alternative Emergency Contact Name (this person will be contacted if we cannot get hold of the above in an emergency)

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* 14. Relationship to Young Person

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* 15. Tel Number

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* 16. Please select which sessions you would like your young person to attend (please ensure they are attending the right session for their age)

  Group 1 (Age 8-11) - 4-4.45pm Group 2 (Age 12-16) - 5-5.45pm Group 3 (Age 16-21) - 6-6.45pm
Tuesday 7 July
Tuesday 21 July
Tuesday 4 August
Tuesday 18th August

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* 17. Are there any access needs we may need to be aware of? (e.g. mobility)

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* 18. Is there anything we can do to support the young person's participation?

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* 19. Are there any medical conditions we may need to be aware of? (e.g. allergies, any regular medication taken)

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* 20. Email address the Zoom link should be sent to

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* 21. Name of the Zoom account holder (name appearing on screen)

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* 22. Please tick the boxes if you consent to the following:

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* 23. You acknowledge that it is the parent/guardian's responsibility to update Wiltshire Creative with any change in contact details

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* 24. You confirm that you have read the guidance available on the relevant page of the Wiltshire Creative website. Click here to read the document.

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* 25. What are you hoping to gain by taking part in this activity?

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* 26. Signed (a typed name will be acceptable in this instance)

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* 27. Date

Date
Payment - This activity is free at this time but you may make a donation through our website if you wish by clicking here.
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