Nenagh Youth Theatre Membership Form

Section A: Member Details

Name

Date of Birth:

Gender

Address Line 1

Address Line 2

Address Line 3

Email Address

Mobile No

What Programme is your first preference for 2024/2025? NYT Players or NYT Explorers?

How did you hear about Nenagh Youth Theatre?

Section B: Parent(s) / Guardian(s) Details

Parent/Guardian 1 Name

Email Address

Home Telephone

Mobile No

Parent/Guardian 2 Name

Email Address

Home Telephone

Mobile No

Tick to consent
I (Parent/Guardian) consent to be contacted for the purpose of verifying my identity as parent/guardian of my child.

Medical Conditions / Additional Requirements
If you answer 'yes' to any of the below, please give details on the form or contact artsadmin@nenagharts.com in confidence.
Please not that any information may have to be shared with others in the interest of your child's welfare. Any information provided with be treated as confidential and managed in line with the youth theatre's Confidentiality Policy.

1. Does your son/daughter/ward have any additional requirements? e.g. physical disability, learning difficulties or literacy issues. YesNo
If 'yes' please give details

2. Does your son/daughter/ward have any medical conditions of which we should be aware? YesNo
If 'yes' please give details

3. Have you been advised by your doctor that your son/daughter/ward is in an 'at risk' group in relation
to COVID-19? YesNo
If 'yes' please give details and contact artsadmin@nenagharts.com regarding their safe participation.

4. Does your son/daughter/ward have any allergies? YesNo
If 'yes' please give details

5. Is there any other information we need to be aware of that may impact on your son's/daughter's/ward's participation in youth theatre? YesNo
If 'yes' please give details

Section C: Parental Consent
Tick to Consent
I give consent for:

1. My son's/daughter's personal data, as provided, to be processed in line with the purposes detailed in the Privacy Statement at the end of this form. YesNo

2. My son/daughter to attend weekly drama workshops. YesNo

3. Photographs/Video Footage including my son/daughter can be used publicly in posters/flyers and/or newspapers for publicity purposes. YesNo

4. Photos/Video Footage to be stored and used for archival purposes (All photos/video footage will be managed in line with the youth theatre's Use of Images Policy). YesNo

5. First aid/medical assistance to be sought in the case of an emergency. YesNo

6. I have informed the youth theatre of relevant information with regard to any medical conditions or additional requirements that relate to my son/daughter/ward through this form or through discussions with a youth theatre leader. YesNo

7. I have read the COVID-19 Procedures for Tipperary Youth Theatre. YesNo

8. I have completed the COVID-19 Declaration Form for my son/daughter/ward, and can confirm that they have no symptoms of COVID-19, are not self-isolating and are not awaiting results of a COVID-19 test. I understand that if there is any chance in this status, they cannot attend youth theatre, their GP must be contacted, and they must self-isolate for the required period. YesNo

9. I have read the information provided by the youth theatre. YesNo

10. I give consent to the above member to participate in online workshops. YesNo

11. I understand that with the current pandemic, workshops may be moved online YesNo

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Signed
Date
*If you wish to discuss payment, paying by installments, bursaries or any other matter in relation to the above, please do not hesitate to contact Jo Quinn at tipperaryyt@gmail.com Section D Members' Consent I give my consent for photos/footage of me to be taken during youth theatre activities and for them to be used for publicity and for the youth theatre archive. YesNo I have read the COVID-19 Procedures for Nenagh Youth Theatre YesNo DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application. Signed
Date
Additional Information relating to Medical Conditions or Additional Requirements Please note if you would like to discuss any of the information regarding your son's/daughter's medical condtitions or additional requirements with us, please contact artsadmin@nenagharts.com Privacy Statement The personal data requested in this form is collected solely for the purpose of supporting you son's/daughter's participation in Nenagh Youth Theatre. Data such as contact details will be used to communicate with you and your son/daughter in relation to your son's/daughter's membership of youth theatre. Data such as gender and age us used to ensure your son/daughter is assigned to aspects of the youth theatre activities that are age appropriate. It also helps us to make accommodation and other arrangement in the case of trips or residentials your son/daughter may participate in during their membership of youth theatre. Details of your son's/daughter's age and gender are also provided to funders and Youth Theatre Ireland to generate statistical information but are aggregated with all member and not directly linked to your son/daughter personally or used to identify your son/daughter to third parties in any way. Sensitive personal data such as details of medical conditions or other personal need are collected so that we can ensure the safety and welfare of your son/daughter whilst participating in the youth theatre. Information that is given in this form in relation to being in an 'at risk' category for COVID-19 will be used to support a young person's safe participation in youth theatre activities during the pandemic. The accompanying COVID-19 Declaration Form will be deleted immediately once it has been assessed by youth theatre leaders, has been recorded as received and any necessary follow-up action has been taken.Nenagh Youth Theatre is collecting this sensitive personal data for the purposes of maintaining safety at youth theatre activities due to the COVID-19 Pandemic. The legal basis for collecting this data is based on vital public health interests and maintaining occupational health. Your son's/daughter's personal data will only be shared with those who need to know it, and only disclosed to a third pary in the case of an emergency such as if they become ill or have an accident that requires medical attention. Images including video will be collected for the purpose of promoting and documenting the activities of Tipperary Youth Theatre, and for archival purposes. Images will be managed safely in line with our Use of Images Policy. The promotion of our productions and other events requires that on occasions images will be used in the public domain. Nenagh Youth Theatre will retain personal data for the duration of that young person's membership in the youth theatre and for 2 years after they leave, when it will be destroyed. Personal data in the form of photographic images and video will be retained permanently or until such time they become obsolete for the purpose of promoting and documenting the activities of Nenagh Youth Theatre. Your rights: Nenagh Youth Theatre is committed to upholding yours and your son's/daughter's rights as provided for by the General Data Protection Regulation (GPDR) including:

To be completed by the Parent/Guardian
I consent to the use of personal data provided for the purposes outlined in the above privacy Statement.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Signed
Date