Apply to Renew a Chaperone Licence - West Berkshire Council

A chaperone is responsible for the supervision of a child who is taking part in entertainment.

1. Friendly Url
2. Friendly Url
4. Unique Reference Number
All information given in this application form will be treated in confidence, other than information relating to criminal offences.
Applicant details
1. Name
  1. Title
  2. Other Title
  3. First Name*
  4. Last Name*
2. 1. Date of Birth*
  2. dd/mm/yyyy
3. Address Postcode
  1. Postcode
    
    Address
4. Address Details
  1. Building Number
  2. Building Name
  3. Address Line 1
  4. Address Line 2
  5. Town / City
  6. County
  7. Postcode
5. 1. Email*
6. 1. Telephone / Mobile
  3. Numbers, spaces, + , ( , and ) are all valid characters
7. 2. Date from when renewal is required
    
    dd/mm/yyyy
  3. If for a specific show, please give full details
  4. Which Theatre Group / Dance School are you connected with?
1. * Please correct any of the validation issues highlighted above