ࡱ > R bjbjzz 3 PgPg e 4 L L R R R f f f 8 D d f I d F \ r r r r> r> r> I I I I I I I $ K N +I R r> = = | r> r> +I r r @I :A :A :A r> ^ r R r I :A r> I :A :A V G @ 0 " H r PEY > ^ -H H VI 0 I 9H x O .? O H O R H @ r> r> :A r> r> r> r> r> +I +I 4@ r> r> r> I r> r> r> r> O r> r> r> r> r> r> r> r> r> L X : Education Welfare Service The Children Performances (Regulations 1968) as amended Applicant Details Name of Amateur Company: Name of applicant: Position in the Company: Address for correspondence: Town: County: Postcode: Tel. no: Mobile: Email address: Performance Details Performance title: Location of performance: Dates of performances Times of performance 1. 4. 1. 4. 2. 5. 2. 5. 3. 6. 3. 6. Declaration of the compliance to The Children Performances (Regulations 1968) as amended for this application for a Body of Persons Licence. I confirm that no payment in respect of taking part in the performance/s, other than for off setting expenses, will be made to any young person or to their representative such as a parent/carer. I confirm that all the young peoples parents/carers have confirmed that they are fit and that their health will not suffer by taking part in the performances. I confirm that suitable arrangements have been made for the young people to get to and from the place/s of performance. Signed: Dated: Full name: Position in the company: Name of organisation: Body of Persons Application: For Production of: Membership List children Name Date of birth Address 1234567891011121314151617181920 Name of Organisation: Body of Persons Application for production of: Adult helper list/licensed Chaperones Name/AddressLicence no. CRB Certificate noCRB Issuing BodyIssue date1.2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Please return this form to: The Child Employment Adviser, Education Attendance Service, The Learning Trust 1 Reading Lane Hackney, London E8 1GQ Email: HYPERLINK "mailto:carla.richardson@learningtrust.co.uk" carla.richardson@learningtrust.co.uk PAGE 2