Peter Pan: A Swashbuckling Family Pantomime

Note for applicants completing this form

After completion, if you have successfully submitted the form, you should receive a successful submission message. If you do not it may be because you have not completed a required field. After your form has successfully gone through you will also receive notification via email. If you do not receive an email please contact the office on 01908 240 831 as there may have been a problem with your application.

Applicant details

Please fill out the details for each member of your family attending the activity.

Supporting documentation If the applicant is registered, please include a copy of one of the following registration documents: - Certificate of Vision Impairment (CVI) - Blind Registration Card issued by local authority If the applicant is not registered, please provide: - a letter from an ophthalmologist confirming visual acuity. Please note, applications cannot be processed without these documents.

To be signed by the applicant or a responsible person.
a. I agree to take part in VICTA's activity and have read all the information sent to me.
b. I acknowledge the need to behave responsibly at all times during the activity.
c. I confirm that this form has been completed accurately and I undertake to update VICTA's organisers should any information contained on the form or personal circumstances change.
d. I give consent for VICTA to carry out the following in accordance with the UK Data Protection Act (1998) and to store my personal information on VICTA's database and/or any other suitable system.
e. I understand that there will be no VICTA staff or volunteers present at this activity, and if I have any medical, dietary or mobility needs I will contact the venue directly in advance to discuss these with them. By signing this form you consent to VICTA using the information supplied for the purpose of administering the named event. All the information will be treated in the strictest of confidence and made available only to those staff working with the participant. We may need to share your details with third party suppliers in relation to this activity. Contact information will be retained and used for marketing of other relevant services. I give consent for VICTA to carry out the following in accordance with the Data Protection Act (1998) and to store my personal information on VICTA's database and/or any other suitable system.