1. |
Full name of child |
John James Smith |
2. |
Date of birth of child |
1 January 1994 |
3. |
Address of child |
10 Anyroad, Any Town, Essex |
4. |
Name and address of schools attended by the child during the 12 months preceding the date of this application or, if (s)he has not attended school, the name and address of his/her private teacher |
St Whatsits School, That Street, Anytown, Essex (From Sept 2003)
The Village School, This Road, That Town, Hampshire (Until July 2003) |
5. |
Particulars of each licence granted during the 12 months preceding the date of this application by any local authority other than the licencing authority to whom this application is made, stating in each case:-
(i) The name of the local authority
(ii) The date on which the licence was granted
(iii) The dates and nature of the performances or activities |
(i) Hampshire County Council
(ii) 1 June 2003
(iii) 30 June & 1 July 2003, filming 'Supersuds' Advert |
6. |
Particulars of each licence granted during the 12 months preceding the date of this application and refused by any local authority other than the licencing authority to whome this application is made, stating in each case:-
(i) The name of the local authoriy
(ii) The date of the application
(iii) The reasons (if known) for the refusal to grant a licence |
None
(unless your child's application was rejected then details are required) |
7. |
Particulars of each performance for which a licence was not required in which the child took part during the 12 months preceding the date of this application stating in each case:-
(i) The Date
(ii) The Place
(iii) The nature of the performance
(iv) The name of the person responsible for the production of the performance, in which the child took part. |
(i) 2 & 3 May 2003
(ii) That Town Theatre, That Town, Hampshire
(iii) Dance school production
(iv) Miss A. Teacher |
8. |
Dates (if any) on which the child has been absent from school during the 12 months preceding the date of this application by reason of his/her taking part in a performance or activity |
30 June & 1 July 2003 |
9. |
Particulars of any other form of employment in which the child is employed during the 28 days preceding the day of the first performance or first activity for which the licence is requested stating:-
(i) The nature of the employment
(ii) The days on which the child is employed
(iii) The times during which the child is employed |
None
(unless your child has had some other employment during the 28 days before the rehearsals or performance, that this application relates to. In which case, the details are needed here) |
10. |
Particulars relating to the sums earned by the child during the 12 months preceding the date of this application stating:-
(i) Whether the sums earned were in respect of performances for which a licence was granted, peformances for which a licence was not granted or other forms of employment
(ii) The amount of the sums
(iii)The date on which payment was received
(iv) The name, address and description of the person from whom the payment was received |
(i) Payment for 'Supersuds' advert, licenced
(ii) £244.80 (£320 less £75.20 (£64 +Vat) paid to the agent)
(iii) 10 September 2003
(iv) Payment received from Agent
Mr. My Agent, Agent House, His Street, That Town, Hampshire |