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Nelson & Burnley Showcase Consent Form Consent Form - Nelson & Burnley - February 2025 DetailsName of Dancer (As you wish for it to appear on T-shirts, show credits etc)*Age of Dancer on 14th February 2025*School Information*Please selectSchool Year 1-11School LeaverEmergency Contact Number 1 of 3*Emergency Contact Number 2 of 3*Emergency Contact Number 3 of 3*Medical Conditions/Additional NeedsPlease give any details of medical conditions/medication or additional needs that you feel we need to be made aware of whilst your child is in our care at the production. (Please only give if relevant) Confirmation of Fitness*I confirm that the participant listed above is suitably fit and well for taking part in the show production and will advise if any changes to this. Yes No Photo/Video for Social Media/Marketing*I give permission for photographs and videos to be taken of the above participant for use on social media and other marketing materials Yes No Show Filming*I give permission for the above participant to be included in the professionally filmed edit of the show production which will be made available to family & friends of the production cast. Yes No Cast List*I give permission for the participant listed above to be included on all published versions of the cast list i.e. T-shirt, souvenir programme etc Yes No Data Sharing*I give permission for the information provided to passed on to the licensed chaperones looking after participants backstage (i.e. medical conditions, emergency contact numbers etc) Yes No Participant Collection*I understand that all participants up to school year 11 must be collected from the designated sign in/out area which will be outlined in advance. This applies to all rehearsals and shows at the theatre. Yes No Answered NO to any of the above?If you have answered NO to any of the above, please provide further information in the box below Good Luck MessageIf you have a short good luck message that you would like us to use on show materials, social media etc please note below.
