YOUTH THEATRE APPLICATION FORM
Name of Student………………………………………………………………………Age……………………
Date of Birth……………/………………/…………….
Name of Parent / Guardian ………………………………………………………………………………......
Address……………………………………………………………………………………………………….....
……………………………………………………………………………………………………………………...
Post Code………………………………………
Telephone Numbers: Please list all relevant telephone numbers below that you are willing to share with us. It is sometimes necessary to contact you at short notice to inform you of a change in the schedule or keep you informed about Youth Theatre matters. If you would prefer your son / daughter to be the first point of contact in such instances please provide their contact mobile number (by doing this you consent to the Palace Theatre representatives contacting the above named student directly).
Home phone number. ……………..……………Parent’s mobile number:……………………………
Additional/Emergency Contact Names and Telephone Numbers:
Contact 1: ..……………………………………………..Telephone Number:………………………………………..
Relationship to Child:……………………………………………………………………………………………………..
Contact 2: ..……………………………………………..Telephone Number:………………………………………..
Relationship to Child:……………………………………………………………………………………………………..
Student’s Mobile Number(only for students over the age of 13)………………………………………………….
Email Addresses: Please list an up-to-date email address we can send relevant Youth Theatre information to in order to keep you informed. If you wish your son/daughter to receive emails directly from the Palace Theatre representatives regarding Youth Theatre business only, please list below (by doing this you consent to the Palace Theatre representatives contacting the above named student directly). It should be noted that any communication via email will be sent to you as well as the student so you are aware of exactly what has been sent. Information will not be sent to a student under the age of 16 years if there is not a corresponding parental / guardian email address to send information.
Parent / Guardian Email address:…………………………………………………………………………..
Student’s Email address (only for students over the age of 13):…………………………………………….
ANY RELEVANT MEDICAL INFORMATION:(if this is not applicable please write ‘none’)
……………………………………………………………………………………………………………………..
…………………………………………………………...... …………………………………………………….
……………………………………………………………………………………………………………………
My child/young person would like to attend: Classes are named ‘Stage Left’ or ‘Stage Right’ to distinguish which class is which – both classes of the same age group will be following the same curriculum. You can circle both classes of the same age group if you have no preference on day or time that your young person would like to attend. You will notice that at age 12 there is an ‘overlap’; we have found at this age that students would prefer to have the choice of which age group they feel more comfortable with.
Junior Youth Theatre (Drama & Music)
5-7 yr olds
Saturday 9:00–10:30am
IntermediateYouth Theatre Groups
Stage LeftStage Right
8-12 yr olds 8-12 yr olds
Saturday 11am–1pm Saturday 1.30 – 3.30pm
Senior Youth Theatre Group
12-15 yr olds
Friday 6-8:30pm
Chapter 4 Youth Theatre Group
16-19 yr olds
Wednesday 6–8:00pm
For current fees please contact Mansfield Palace Theatre on 01623 412921
You will be notified when a place is made available. The first lesson will be a free ‘taster’ session.
Fees can be paid on a half termly or termly basis and all classes must be paid for prior to the class starting.
Fees can be paid in person at the Box Office in the main Theatre entrance or by telephoning the Box Office
on 01623 633133 and making payment by card.
Annually – Each student will be charged around £6.00 for the price of a script, when required for productions,
which they will be allowed to keep at the end of the show.
Please return this form to :
Lisa Hopkinson – Youth Theatre Administrator, Mansfield Palace Theatre, Leeming Street, Mansfield,
Nottinghamshire NG18 1NG
Tel: 01623 412927
PARENTAL AGREEMENT
(Please sign both copies and return one with the enrolment form)
I understand and agree to the following statements…
I give permission for my child to attend the Youth Theatre and participate in all activities and special events.
Youth Theatre staff are only responsible for my child/young person during stated activity times.
Youth Theatre is a not-for-profit, self-financing organisation. I will support by promoting events and encourage a high level of commitment from my child/young person.
Due to a waiting list for places an unexplained absence for three consecutive sessions may forfeit my child/young person’s place on the programme.
I am responsible for the welfare of my child/young person. Mansfield Palace Theatre and Mansfield District Council are not liable should any incident occur prior to, or post sessions.
Dropping Off and Collection
Junior and Intermediate students MUST be dropped off and collected by a Parent / Guardian from the Rehearsal Room (upstairs in the Palace Theatre where all Youth Theatre activities take place), ensuring that they are received and registered by the Youth Theatre tutor with the reverse happening at the end of the session. The only exception to this rule is an Intermediate student will be allowed to leave the building if the Disclaimer Form attached is completed and returned with this form.
Please put a tick in the box if you have completed and signed the Disclaimer Form.
Senior and Chapter 4 students
Please initialthe box to agree to the student entering and leaving the building without supervision.
Use of different forms of Media
Photographs and Video recordings are used to document the work of the Youth Theatre or for publicity purposes (including social media) in order to evaluate and promote the group.
Please initial the box if you give permission for the above named student to appear in
photographs / video recordings for the purposes of Mansfield Palace Theatre only.
On occasions outside educational organisations such as Colleges are invited to work with the students of the Youth Theatre to provide valuable experience to college students in training and equally provide the Youth Theatre members with a variety of different theatre experiences and workshops.
Please initial the box if you give permission for the above named student to be photographed or captured on video for educational / assessment purposes only and where a reputable educational organisation holds one copy only for the purpose of college student practical assessment.
NAME OF STUDENT………………………………………………………………………………………………………
NAME OF PARENT/GUARDIAN(please print, including title)
………………………………………………………………………………………………………………………………...
SIGNATURE OF PARENT/GUARDIAN………………………………………………………………………….
DATE…………………/…………………/…………………
PARENTAL AGREEMENT
(Please sign both copies and return one with the enrolment form)
I understand and agree to the following statements…
I give permission for my child to attend the Youth Theatre and participate in all activities and special events.
Youth Theatre staff are only responsible for my child/young person during stated activity times.
Youth Theatre is a not-for-profit, self-financing organisation. I will support by promoting events and encourage a high level of commitment from my child/young person.
Due to a waiting list for places an unexplained absence for three consecutive sessions may forfeit my child/young person’s place on the programme.
I am responsible for the welfare of my child/young person. Mansfield Palace Theatre and Mansfield District Council are not liable should any incident occur prior to, or post sessions.
Dropping Off and Collection
Junior and Intermediate students MUST be dropped off and collected by a Parent / Guardian from the Rehearsal Room (upstairs in the Palace Theatre where all Youth Theatre activities take place), ensuring that they are received and registered by the Youth Theatre tutor with the reverse happening at the end of the session. The only exception to this rule is an Intermediate student will be allowed to leave the building if the Disclaimer Form attached is completed and returned with this form.
Please put a tick in the box if you have completed and signed the Disclaimer Form.
Senior and Chapter 4 students
Please initial the box to agree to the student entering and leaving the building without supervision.
Use of different forms of Media
Photographs and Video recordings are used to document the work of the Youth Theatre or for publicity purposes (including social media) in order to evaluate and promote the group.
Please initial the box if you give permission for the above named student to appear in
photographs / video recordings for the purposes of Mansfield Palace Theatre only.
On occasions outside educational organisations such as Colleges are invited to work with the students of the Youth Theatre to provide valuable experience to college students in training and equally provide the Youth Theatre members with a variety of different theatre experiences and workshops.
Please initial the box if you give permission for the above named student to be photographed or captured on video for educational / assessment purposes only and where a reputable educational organisation holds one copy only for the purpose of college student practical assessment.
NAME OF STUDENT ………………………………………………………………………………………………………
NAME OF PARENT/GUARDIAN (please print, including title)
………………………………………………………………………………………………………………………………...
SIGNATURE OF PARENT/GUARDIAN………………………………………………………………………….
DATE…………………/…………………/…………………
MANSFIELD PALACE YOUTH THEATRE
DISCLAIMER FORM
NAME OF STUDENT …………………………………………………………………………………………...
YOUTH THEATRE CLASS …………………………………………………………………………………….
I agree to the above named student arriving and leaving unaccompanied before and after the Youth Theatre Class at the Mansfield Palace Theatre.
NAME OF PARENT / GUARDIAN (please print, including title)
……………………………………………………………………………………………………………………
SIGNATURE OF PARENT / GUARDIAN
……………………………………………………………………………………………………………………
DATE ………………………………………………….