Apply For a Chaperone Licence

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
1. * Please correct any of the validation issues highlighted above