<p> Playhouse Youth Theatre Expression of Interest Form Term One will begin w/c: 14 September 2016 Preferred Youth Theatre Group (if known): Young Person’s Name: </p><p>D.O.B: Age:</p><p>Address: I identify my gender as:</p><p>School/College attended: Postcode: </p><p>Young Person’s Contact Number (if applicable): (To be used as our primary contact number) </p><p>Please enter two separate contact details in case of an emergency:</p><p>Emergency Contact 1 Name: Emergency Contact 1 Number: Relationship to young person: </p><p>Emergency Contact 2 Name: Emergency Contact 2 Number: Relationship to young person: </p><p>Young Person’s Email Address (if applicable): </p><p>Parent/Guardian’s Email Address:</p><p>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? </p><p>(Please Highlight or Circle) Yes No</p><p>Would you like to join our mailing list for information about projects, performances, work at First Floor and auditions for young people? </p><p>(Please Highlight or Circle) Yes No</p><p>Please complete Page 2 </p><p>Do you currently attend a youth theatre/drama group? Please give the group name(s), length of membership(s) and brief performance information.</p><p>Do you consider yourself to have a disability? (Please Highlight or Circle) Yes No</p><p>If yes, please give details below and outline any particular needs/access requirements you may have:</p><p>Please note any medical information, conditions or allergies we should be aware of: </p><p>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.</p><p>How did you hear about the Playhouse Youth Theatre? </p><p>Parent/Carer Consent (If under 18) </p><p>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.</p><p>Sign: Date: </p><p>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.</p><p>For further information or to return this form, contact: [email protected] You can also post this form to: Kirsty Pennycook, Youth Theatre, West Yorkshire Playhouse, Playhouse Square, Quarry Hill, Leeds, LS2 7UP</p>