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1. Name: (Required.)

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2. How old are you (Required.)

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3. What type of act/performance will you be doing? (Required.)

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4. Will you be performing solo or as part of a group? (Required.)

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5. If you are performing as part of a group, please provide the names of everyone taking part and your group name (if applicable). (Required.)

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6. If your performance requires music, please provide the artist and song title.
If you are using a backing track, please include this here too. (Required.)

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7. Does your act require any specific equipment or technical requirements?
For example: microphone, instrument, backing track, projector, etc. (Required.)

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8. Please upload a photo of yourself.
This may be used to introduce/promote performers for Whitworth’s Got Talent. (Required.)

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9. Is there anything else you would like us to know about your act? (Required.)

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10. Are you happy for photos/videos of you taken as part of Whitworth’s Got Talent to be used for promotional purposes, including social media? (Required.)

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11. PARENT / GUARDIAN CONSENT — FOR PERFORMERS UNDER 18
If the performer is under 18, a parent or legal guardian must tick the box below to confirm that they give permission for the young person to take part.

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12. Parent / guardian name

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13. Relationship to performer

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14. Contact telephone / email

Signature

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15. Signature

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