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Walnuts Application Form 2023/24
Please complete this form to sign up for Discarded Nut's adult acting company The Walnuts.
Mondays: 10-11.30am
@ The Nutshell, Winchester
£125 per term (10 weeks) ages 18+
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Full Name
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Your answer
Pronouns
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Address Line 1
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Your answer
Address Line 2
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Address Line 3
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Town
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County
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Postcode
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Telephone Number
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Email Address
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Preferred Method of Contact
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Email
WhatsApp
Phone Call
Previous Experience
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How did you hear about the Walnuts?
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Your answer
Do you suffer from any illness, allergy (including food allergies) or condition requiring medication?
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Yes
No
If yes, please provide details
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Do you take regular medication?
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Yes
No
If yes, please provide details
Your answer
Do you wear contact lenses?
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Yes
No
I give consent for photos/videos to be taken.
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Photos/videos may be used for promotional purposes and so, if used, will be going out in to the public domain
Yes
No
GP Name and Address
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GP Phone Number
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Your answer
Additional Emergency Contact Name
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Additional Emergency Contact Mobile Number
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Additional Emergency Contact Home Telephone Number
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Can we add you to our Mailing List?
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