Preferred Youth Theatre Group (if known):
Young Person’s Name:
D.O.B: / Age:
Address:
Postcode: / I identify my gender as:
School/College attended:
Young Person’s Contact Number (if applicable):
(To be used as our primary contact number)
Please enter two separate contact details in case of an emergency:
Emergency Contact 1 Name:
Emergency Contact 1 Number:
Relationship to young person:
Emergency Contact 2 Name:
Emergency Contact 2 Number:
Relationship to young person:
Young Person’s Email Address (if applicable):
Parent/Guardian’s Email Address:
Do we have your permission to take rehearsal and performance videos and photographs of you for marketing, press and archive purposes, including WYP social media?
(Please Highlight or Circle) Yes No
Would you like to join our mailing list for information about projects, performances, work at First Floor and auditions for young people?
(Please Highlight or Circle) Yes No
Please complete Page 2
Do you currently attend a youth theatre/drama group? Please give the group name(s), length of membership(s) and brief performance information.
Do you consider yourself to have a disability?
(Please Highlight or Circle) Yes No
If yes, please give details below and outline any particular needs/access requirements you may have:
Please note any medical information, conditions or allergies we should be aware of:
How would you define your ethnicity? (E.G: White British, Asian British, Caribbean, Chinese)
This information is used for monitoring purposes only, and is optional.
How did you hear about the Playhouse Youth Theatre?
Parent/Carer Consent (If under 18)
I confirm that the details on this form are correct, and give permission for [name of young person] to take part in the Playhouse Youth Theatre sessions and performances.
Sign: / Date:
Please note that receipt of this form is not confirmation of a place.
You will be contacted separately via email to confirm a place within the Playhouse Youth Theatre.
For further information or to return this form, contact:
You can also post this form to:
Kirsty Pennycook, Youth Theatre, West Yorkshire Playhouse,
Playhouse Square, Quarry Hill, Leeds, LS2 7UP