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
1
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
2
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
1
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.
2
E.g. theatrical, musical, dancing, filming, sport, modelling
1
V.3 (May 15)
risks, physical, emotional or
psychological, to the child
3
.
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
4
, 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
5
:
b) the approximate duration on
each day:
c) the reason that the performance
must take the form of night
work
6
:
3
It should not be necessary to provide a script the description of the activity and context is more important.
4
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.
5
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).
6
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.
2
V.3 (May 15)
10) a) The sums to be earned by the
child in taking part in the
performance or activity:
b) The name, address and
description
7
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
7
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?
3
V.3 (May 15)
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.
4
V.3 (May 15)
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:
OR
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
8
, stating -
a) The name of the authority:
b) The date the licence was granted:
c) The dates and nature of
performances or activities:
8
This will only be relevant if the child has moved between authorities in the last 12 months.
5
V.3 (May 15)
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
9
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:
9
By virtue of section 37(3) of the Children and Young Persons Act 1963
6
V.3 (May 15)
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
10
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:
10
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.
7
V.3 (May 15)
I attach the following:
(a) A copy of the child’s birth certificate (scanned copies are acceptable please
do not send original hard copies)
11
;
(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)
12
;
(c) A copy of the contract, draft contract or other documents (where they exist)
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
11
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.
12
The image must not be altered or enhanced in anyway. It should be a full head shot taken in good light.
8
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*
*
I
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.
9