1 Start 2 Complete Participants Full Name * Address * Postcode * Phone Number * Carer/Contact Name(s) * Please provide as many carers names and numbers as possible Carer/Contact Number(s) * Emergency Contact Name this can be the same as the carers stated above Emergency Contact Number this can be the same as the carers above Does the participant have any health issues we should know about? What additional needs does the participant have? Is there anything else we should know? Workshop(s) participant is attending Prism Drama Motion Dance Photo and Video Consent yes no Workshops, rehearsals, performances may be filmed and/or photographed for promotional and social media material. Do you consent to this? Please Sign Signer Name Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20232024202520262027
