10.01.2019 Years 5 & 6 Alderman White Consent Form

Please return to your primary school and forward to Karsten Stephan at Alderman White School, Chilwell Lane, Bramcote, Nottingham NG9 3DU

Email: karsten.stephan@whpfederation.org

Alderman White School Theatre Project for pupils in Years 5 & 6:

‘Around the World in 80 Minutes’

I would like my son/daughter to audition for the above project on Wednesday 16th January

5.00 – 6.30 pm. I also agree to him/her taking part in the rehearsals and performances of the play as outlined in the letter and agree to take responsibility for his/her safe journey to and from these rehearsals. I also accept that photos may be taken of the show and that a video-recording may be made of the performance.

Pupil’s name: ………………………………………………………………………

(Please print)

Primary School: ……………………………………………………………………...

Date of Birth: ...…………………………………………………………………...

Parent’s/Carer's name: ….………………………………………………………………….

(Please print)

Parent’s/Carer’s contact no: ..……………………………………………………………………..

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Address: . .…………………………………………………………………….

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Health or diet-related issues of which staff at Alderman White should be aware:

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Parent’s/Carer’s Signature: …………………………………………………………………….