Fill - Free fillable The Children and Young Person Acts 1933 and (Leicestershire County Council) PDF form

V.3 (May 15)

The Children and Young Person Acts 1933 and 1963

The Children (Performances and Activities) (England)

Regulations 2014

Standard Child Performance and Activities Licence Application

Form (England)

Note: this form should be completed and submitted to the licensing authority where

the child resides not less than 21 days before the first performance or activity for

which the licence is requested, since the licensing authority may otherwise refuse to

grant a licence.

Part 1: Information to be provided by the applicant about the performance or

activities

Title:

Name:

Job title:

Company:

Address:

Tel:

Mobile:

Email:

1) Does your organisation have a child

protection or safeguarding policy?

b) When was this last updated?

Please insert a link or attach a copy.

Note: it is best practice that organisations that involve children in performances, paid

modelling or paid sport have or develop a child protection policy, regularly review

and update it, and ensure that all staff and volunteers are familiar with it.

2) Name and nature

of the

performances or activities in respect of

which the licence is requested:

3) Please provide as full a description as

you can about what the child will

actually be required to do. Include

information about the environment

they will be asked to do it in, and any

other contextual information that may

help us in assessing the potential

Schedule 2 Part 2 of The Children (Performances and Activities) (England) Regulations 2014 sets out the

information to be provided by the applicant about the performance or activities.

E.g. theatrical, musical, dancing, filming, sport, modelling

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risks, physical, emotional or

psychological, to the child

4) If you have completed a risk assessment please attach it to this application.

See the sector led best practice guidance for further information about risk

assessments.

5) Place of activities, performances and

rehearsal for which the licence is

requested, including any periods on

location:

6) The dates and times of activities,

performances or rehearsals for which

the licence is requested:

If the dates are not known at this

time

, please provide the number of

days and the period during which it is

requested that a child may take part in

activities, performances or rehearsals.

7) The expected total running time or

duration of activities or performances

(including any rehearsal) in respect of

which a licence is requested:

8) The approximate duration of the

child’s appearance in the performance

or activity:

9) The amount of night work (if any) for which approval is being sought and please

state:

a) the approximate number of

days

b) the approximate duration on

each day:

c) the reason that the performance

must take the form of night

work

It should not be necessary to provide a script – the description of the activity and context is more important.

This might be because the filming schedule cannot be fixed in advance, or the activity is dependent on

weather conditions. See paragraph 1.7.2 of the advice issued by the Department for Education.

For these purposes any performance taking place after midnight and before the earliest permitted hour

counts as an extension to the previous day. E.g. if the child performs on Tuesday and then performs after

midnight, in the early hours of Wednesday, that counts as one day (Tuesday).

The local authority may want assurance that there is a good reason why the child is asked to take part in a

performance or activity at night.

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10) a) The sums to be earned by the

child in taking part in the

performance or activity:

b) The name, address and

description

of the person to

whom or to which the sums are

to be paid (if not to the child in

question):

11) Where a licence is requested in

respect of a performance, the

proposed arrangements for any

rehearsals prior to the first

performance for which a licence is

requested. For each rehearsal

please state the date, the place, and

the approximate time and duration:

12) The days or half days on which leave

of absence from school is requested

to enable the child to take part in the

performance, rehearsals or activity:

13) Proposed arrangements (if any) for the education of the child during the period

for which the licence is requested stating -

a) Where the education is to be

provided by a school, name and

address of the school:

b) Where the education is to be

provided other than by a school:

i. name, address and qualification

of the proposed teacher;

ii. the place where the child will be

taught;

iii. the proposed course of study;

iv. the number of other children to

be taught at the same time by

the same teacher and the sex

and age of each child;

v. whether the child is to receive

the amount of education in

accordance with regulation

13(3)(e) of the Children

(Performances and Activities)

(England) Regulations 2014

i.e. if it is an individual what is their relationship to the child, or is it a company or organisation and if so, what

is their relationship to the child?

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14) The name and address of the

proposed chaperone, or the name

and address of the parent or teacher

who will have care of the child:

15) The name of the local authority or (in

Scotland) the education authority (if

any) which has previously approved

the appointment of the chaperone:

16) The number of children to be in the

charge of the chaperone during the

time when the chaperone will be in

charge of the child and the sex and

age of each child:

17) The address of any accommodation

where the child will live, if different

from the place where the child would

ordinarily live, the number of other

children and details of the chaperone

(if any) who will live in the same

accommodation:

18) a) Approximate length of time

which the child will spend

travelling to and from the place

of performance, rehearsal or

activity each day:

b) Arrangements (if any) for transport

there:

c) Arrangements (if any) for transport

back:

19) The name of any other local

authority, or in Scotland, any

education authority to which an

application has been made for

another child to take part in

performances or activities to which

the application relates (if not known

at the time of application, to be

provided when known):

Note: this will help the relevant local authorities to take a consistent approach.

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Part 2: Information to be provided by the applicant in relation to the child

Note: the applicant will usually need to obtain this information from the child’s parent,

and a parent of the child needs to sign the completed form, but the form should be

submitted by the applicant (unless the parent is also responsible for organising the

activity or production). See regulation 4 of the Children (Performances and Activities)

(England) Regulations 2014.

1) Child’s name:

2) Child’s home address:

3) Child’s date of birth:

4) Name and address of the school the

child currently attends:

If the child is not attending school, the

name and address of the child’s

private teacher:

5) Details of each licence in relation to the child granted during the twelve months

preceding the date of the application by any local authority, or in Scotland, any

education authority, other than the licensing authority to which this application is

made

, stating -

a) The name of the authority:

b) The date the licence was granted:

c) The dates and nature of

performances or activities:

This will only be relevant if the child has moved between authorities in the last 12 months.

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6) Details of each application in relation to the child for a licence refused by any

other authority in the last 12 months, other than the licensing authority to which

this application is made, stating -

a) The name of the local authority or

education authority:

b) The reasons (if known) for the

refusal to grant a licence:

7) Details of any performances for which a licence was not required

in which the

child took part during the previous 12 months, stating -

a) The date of the performance:

b) The number of days of

performance:

c) The title of the performance:

d) The name and address of the

person responsible for the

production:

8) Dates (if any) on which the child has

been absent from school during the

twelve months preceding the date of

the application by reason of taking

part in a performance or activity:

9) Amount of any monies earned by the

child during the last twelve months,

stating whether the monies earned

were in respect of performances or

activities for which a licence was

granted or a performance for which a

licence was not required:

By virtue of section 37(3) of the Children and Young Persons Act 1963

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Medical declaration to be completed by child’s parent

Does your child have:

(answer yes or no)

If yes please provide details including any treatment or

medication:

Asthma

Any allergies

Any skin conditions

Hearing impairment

Visual impairment

Any learning disability

Any physical disability

Any medical conditions?

Taking any regular

medication(s)?

Been to see or had a

referral to a hospital

consultant in the last 6

months?

I confirm that I have

parental responsibility

for this child.

Signature of parent:

Print Name:

Postal Address (if

different from child)

Parents Email Address

Parents Telephone No.

Date:

I certify that to the best of my knowledge the details in this application are

correct. I hereby apply for a licence under section 37 of the Children and

Young Persons Act 1963:

Signature of applicant:

(To be signed by person

named on page 1)

Date:

As defined within section 3 of the Children Act 1989, ‘parental responsibility’ means all of the rights, duties,

powers, responsibilities and authority which by law a parent of a child has in relation to the child and his

property.

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I attach the following:

(a) A copy of the child’s birth certificate (scanned copies are acceptable – please

do not send original hard copies)

;

(b) 1 print (un-mounted) of a photograph of the child taken during the last 6

months or an electronic likeness (e.g. a jpeg file)

;

containing details of the agreement regulating the child’s participation in the

performance or activity to which this application relates.

Notes:

1) Electronic versions of this form and electronic documentation are acceptable,

including signatures.

2) You should ensure that the parent/guardian and the chaperone are given a

copy of the whole completed form, which you submit to the local authority.

3) Any person who fails to observe any condition subject to which a licence is

granted or knowingly or recklessly makes any false statement in or in

connection with an application for a licence is liable to a fine not exceeding

£1000 (level 3 on the standard scale) or imprisonment for a term not

exceeding three months or both (section 40 of the Children and Young

Persons Act 1963).

Please return completed application form to:

Child Performance and Employment Team

Children & Family Services

County Hall

Glenfield

Leicestershire

LE3 8RF

Tel: 0116 3056544/ 3057820/ 3056597

In the exceptional circumstance where the child’s birth certificate cannot be provided as part of the

application (e.g. because they don’t have one) the licensing authority may accept alternative evidence.

The image must not be altered or enhanced in anyway. It should be a full head shot taken in good light.

Child Performance & Employment Team

Children & Family Services

County Hall

Glenfield

Leicestershire

LE3 8RF

V.3 (May 15)

PART 3: To be completed by the Head Teacher/ Designate

Name of Child

Title of performance:

Dates of performance:

Dates of school absence (If applicable):

Name of Headteacher/ Designate:

School Name and Address:

Telephone:

Email:

Signature:

Date:

School Stamp:

If school absence is required, do you agree to authorise the absence:

Yes No*

f you do not agree to the absence, please state your reasons why:

The amendments made to regulation 7 of the Education (Pupil Registration) (England) Regulations 2006 on leave of absence do not affect the

section that allows the parent of a child performer to seek leave of absence from school for their child to take part in a performance. The

amendments affect section 3 and 4 of regulation 7, which relate to leave of absence for the purpose of a family holiday.

Section 2 of Regulation 7 (which has not been amended) still enables a head teacher to grant leave of absence for a pupil to undertake

employment during school hours for the purpose of taking part in a performance within the meaning of section 37 of the Children and Young

Persons Act 1963.

Legislation sets out that a local authority licence must be obtained before a child can take part in a performance. Where the licence specifies the

dates that a child is to be away from school to perform, then the head teacher should authorise those days. However, where the terms of the

licence do not specify dates it is at the discretion of the head teacher to authorise leave of absence. Head teachers should be sympathetic to

requests that are supported by a licence, as long as the school remains satisfied that this will not have a negative effect on a child’s education.

If you have any queries in relation to this form, please telephone the Child

Performance and Employment Team on 0116 3056544/ 3057820/ 3056597.

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