Workshop Application Form Please tick the relevant boxes and ensure that any necessary payment and parental signatures have been included before returning this form to GET-IN! Wolverhampton Grand Theatre, Lichfield St, Wolverhampton, WV1 1DE REMEMBER – WE WILL NOT CONTACT YOU UNLESS YOU HAVE NOT GOT A PLACE If you would like any further details or would like to double check then please call us on 01902 57 33 20 If you cannot make it for any reason then please get in touch as soon as possible as if you fail to turn up you may be taking the place that another member could have had. We cannot guarantee any refunds in the event of non-attendance. TICK BOX IF YOU WANT TO ATTEND WORKSHOP “BE CURIOUS” With Frantic Assembly DATE: Wednesday 18th February TIME: 10.30am – 5pm AGES: 14+ COST: £25 VENUE: Newhampton Arts Centre & Wolverhampton Grand Theatre Non GET-IN! Guests I am bringing (if applicable) …………………………………………………………………......................................................... TOTAL I enclose the following amount for workshops: Please make cheques payable to Wolverhampton Grand Theatre 1982 Ltd – please do not send cash by post, any cash applications will need to be made to Grand Theatre Box Office. YOUR FULL NAME AGE MEMBERSHIP NUMBER Contact name of next of kin, their home phone number and MOBILE TELEPHONE - in case of emergency Any serious medical conditions? E.G. epilepsy, diabetes, serious allergies, (All information given on these forms will be treated in the strictest confidence) Are you taking any medication? E.g. asthma inhaler, insulin. If so please provide details below (GET-IN! members must take full responsibility for own medication) Any other information that may be relevant? I.E dietary requirements, special needs. Parental Consent I hereby give consent for the above named minor to take part in the stated workshop(s) and confirm that I am their legal guardian. PRINTED NAME SIGNATURE In some workshops photographs may be taken for publicity purposes such as local paper and Grand Theatre marketing, e.g. brochures, newsletters, Grand Theatre website etc. Please tick the box if you give your consent for the child above to be in these photographs. WE LOOK FORWARD TO SEEING YOU AT THE WORKSHOPS VERY SOON!!!!