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Participant information

Form for Mayflower Participation Team that takes all the details of the participant attending a specific event.

Participant Details

Name(Required)

First Name Surname

Chosen pronouns (e.g she/her, they/them etc.)

Date of Birth(Required)

DD slash MM slash YYYY

Ethnic Origin(Required)

Gender Identifies with(Required)

Female

Male

Non-Binary

Prefer not to say

Other

Contact Email Address(Required)

Contact Phone Number(Required)

Address(Required)

Street Address Address Line 2 City County Postcode Country

Does the participant identify as disabled?(Required)

Yes

No

Please provide details of any medical conditions, disabilities, learning difficulties, access needs, and/or the taking any medication,(this is to understand any support needs that you require during your time with us)

Are you happy for us to take photos/videos of your young person for promotional or historical purposes?(Required)

Yes

No

Do you give permission for the young person to leave the activity alone?(Required)

Yes

No

Monitoring Data

Please note the information below helps us to review our demographic of participants. If you wish not to answer these questions please select prefer not to say.

Emergency Contact Details

Emergency Contact 1(Required)

Email(Required)

Phone(Required)

Emergency Contact 2(Required)

Phone(Required)

Bursary

Do you want to apply for a Bursary?(Required)

Yes

No

Type of Household(Required)

Single Income

Dual Income

Other

Please tick the box that best represents your total household income:(Required)

£0-£19,999

£20,000-£24,999

£25,000-£34,999

£35,000-£45,999

£46,000+

Additional Comments(Required)

Please tick any boxes that the household receives:(Required)

Universal Credit

Housing Benefit

Working and Tax Credits

Job Seeker's Allowance

Income Support

Disability Living

Pension Credit

Are there any other financial circumstances that we should be made aware of?

How do you feel you/the participant would benefit from the bursary?(Required)

How does your young person intend to travel to our venue?(Required)

Walk

Cycle

Car

Bus

Train

Taxi

Other

If travelling by public transport how much would one return journey cost?(Required)

eg. £3.50

Project Consent(Required)

I understand that the participant on this application may not be awarded a bursary and could be required to pay the full fee to participate in the activity. The information given in this application is true and accurate at the time of submission. In some circumstances Mayflower may need to verify the information you have provided.

Agreement(Required)

I consent to this information being processed by Mayflower and their web developers, Substrakt

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Mayflower Theatre

Box Office: 02380 711811

Mayflower Theatre

Mayflower Theatre,
Commercial Road,
Southampton,
Hampshire
SO15 1GE

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Mayflower Studios

Mayflower Studios,
142-144 Above Bar Street,
Southampton,
Hampshire
SO14 7DU

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Mayflower is managed by The Mayflower Theatre Trust. Registered Charity 294745 and Company No. 02026445.
Registered Offices: Mayflower Theatre, Empire Lane, Southampton, SO15 1AP.

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