envision application form - Half A Sixpence/Aladdin

Application form envision Autumn 2019

SOME LIKE IT HIP HOP at the Peacock Theatre

9th November 2019

Pre-show activities: 10.30 to 1.00

Show: 2.30 to 4.30

Please note tickets are very limited. Cost £10 per young person and £15.00 per adult. If oversubscribed, we will prioritise new participants to the programme or those that have previously been unsuccessful. Please contact jo@mousetrap.org.uk with any queries.

Name:

First NameLast Name

School name (if applicable):

Job title/relationship to young person(s) attending:

Borough:

Email:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:

Area CodePhone Number

Mobile:

Age(s) of young people attending:

AGE SUITABIILTY: 7+

How many members of the group have a visual impairment?

Access requirements: Please contact jo@mousetrap.org.uk to discuss wheelchair access

Please describe any additional needs such as learning difficulties or mobility difficulties:

Do you have wheelchair users in your group?

YesNo

How many?

Adults must not outnumber young people, unless there are specific access requirements to necessitate this.

Number of young people (under 18):

Ages of young people

Number of adults:

Total

Anything to add?

Are you happy to receive future offers of audio-described performances from us?*

YesNo

Are you happy to hear news from Mousetrap Theatre Projects in general (about once a year)?*

YesNo

If you have any queries about completing this form, or envision in general, please contact Jo Pelly on 020 7632 4111 or email jo@mousetrap.org.uk

Terms and Conditions

1) Once confirmed, your tickets will be paid for by Mousetrap Theatre Projects and are non-exchangeable, non-refundable, in accordance with the theatre box office's policy.

2) If you cancel your visit, or reduce your numbers within 2 weeks of the event, you will be liable to pay the full cost of £35 a ticket.

3) This event is for families of visually impaired children and their sighted siblings/other family members.

Agree to Terms and Conditions*

I agree