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Home
About
Our Team
Classes
Events Calendar
Productions
Scholarship
Resources
Privacy Statement
Gallery
Photographs
Videos
Membership
New Members
Membership Renewal
Waiting List
Contact
Covid-19 Resources
Home
About
Our Team
Classes
Events Calendar
Productions
Scholarship
Resources
Privacy Statement
Gallery
Photographs
Videos
Membership
New Members
Membership Renewal
Waiting List
Contact
Covid-19 Resources
WHERE THE
STORY BEGINS
Making Magic
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Membership
Ronan Ward
2020-09-23T10:08:07+00:00
Membership Application Form
Section C to be completed by the Parent/Guardian of those aged under 18
Please fill out each section of the below Application Form. Payment with your Credit or Debit Card can be made at the end.
Please enable JavaScript in your browser to complete this form.
1
2
3
4
5
Section A: Member Details (Sibling #1)
Name
*
First
Last
Date of Birth
Email
Mobile
Member Details (Sibling #2)
Fill this section in if you have a second child attending. Go straight to Section B if you don't.
Name
First
Last
Date of Birth
Email
Mobile
Member Details (Sibling #3)
Fill this section in if you have a third child attending. Go straight to Section B if you don't.
Name
First
Last
Date of Birth
Email
Mobile
Next
Section B: 1st Parent / Guardian Details
Name
*
First
Last
Email
*
Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Ireland
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Home Phone
Mobile
2nd Parent / Guardian Details
Name
*
First
Last
Email
*
Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Ireland
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Home Phone
Mobile
Checkboxes
*
I (Parent/Guardian) consent to be contacted for the purpose of verifying my identity as parent/guardian of my child. (Please tick)
Medical Conditions/Additional Requirements
If you do not have sufficient space to provide full details, please complete the attached Additional Information Sheet. Any information provided will 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)
Yes
No
If ‘Yes’, please give details:
Details
2. Does your son/daughter/ward have any medical conditions of which we should be aware?
Yes
No
If ‘Yes’, please give details:
Details
3. Does your son/daughter/ward have any allergies?
Yes
No
If ‘Yes’, please give details:
Details
4. Is there any other information we need to be aware of that may impact on your son’s/daughter’s participation in youth theatre?
Yes
No
If ‘Yes’, please give details:
Details
Next
Section C: Parental Consent
1. My son/daughter/ward personal data, as provided, to be processed in line with the purposes detailed in the Privacy Statement at the end of this form.
Yes
No
2. My son/daughter/ward to attend weekly drama workshops.
Yes
No
3. Photograph/Video Footage of my son/daughter/ward to be taken during youth theatre events.
Yes
No
4. Photographs/Video Footage including my son/daughter/ward to be used publicly in posters/flyers and/or newspapers for publicity purposes.
Yes
No
5. 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).
Yes
No
6. First aid/medical assistance to be sought in the case of an emergency.
Yes
No
If ‘Yes’, please give details.
7. I have disclosed all relevant information with regard to any medical conditions and any additional requirements that relate to my son/daughter of which I am aware.
Yes
No
If ‘Yes’, please give details.
8. I have paid the membership fee. (Section F)
Yes
No
If ‘Yes’, please give details.
Signature
*
Clear Signature
Date
*
Next
Section D: Members’ Consent For Photos
To be completed by Parent/Guardian.
*
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.
Signature
*
Clear Signature
Date
*
Section E: Members’ Consent For Personal Data
Gonzo Youth Theatre will use personal data only where consent to do so is affirmative, freely given, specific, informed and unambiguous. The below privacy statement provides information on why we gather and how we will use your son/daughter/ward personal data.
To be completed by Parent/Guardian.
*
I consent to the use of the personal data provided for the purposes outlined in our Privacy Statement on the Gonzo Youth Theatre Website.
Signature
*
Clear Signature
Date
*
Next
Section F: Gonzo Youth Theatre Membership Payment
You can now pay your Gonzo Youth Theatre Membership online. Simply choose the Class or Term you wish to pay for. Enter your card details and you will receive confirmation of your purchase via email.
Please pick from one of the below:
*
Term 1 (Sept-Dec) - One Sibling - 25,00 €
Term 1 (Sept-Dec) - Two Siblings - 45,00 €
Term 1 (Sept-Dec) - Three Siblings - 65,00 €
Term 2 (Jan-March) - One Sibling - 25,00 €
Term 2 (Jan-March) - Two Siblings - 45,00 €
Term 2 (Jan-March) - Three Siblings - 65,00 €
Term 3 (April-June) - One Sibling - 25,00 €
Term 3 (April-June) - Two Siblings - 45,00 €
Term 3 (April-June) - Three Siblings - 65,00 €
Single Class - 5,00 €
Stripe Credit Card
*
Card
Name on Card
Previous
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