Application to become a chaperone

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To apply for a chaperone licence through us, you must live in a Surrey County Council Borough.

A payment of £40.00 is required. This is to cover the cost of the two mandatory training sessions, and a discounted administration fee. The payment must be made on completion of this form.

Chaperone training takes place every month at Surrey County Council offices at either Woking or Redhill. Please call The Child Employment Team once you have completed this form and made payment to book your place on the next available training sessions.

I apply to Surrey County Council for approval as Chaperone for children in entertainment under the Children & Young Persons Act 1963 and the Children (Performances and Activities)(England) Regulations 2014. I declare that the information provided in this application is true to the best of my knowledge. I consent to confidential routine enquiries being carried out by the Disclosure and Barring Service and of Surrey County Council Social Care Records. I understand that I will be required to attend two, two hour plus sessions on Child Protection and the Roles and Responsibilities of being a chaperone before I will become registered. I agree to the references I provide being contacted as part of the chaperone application process. *

I agree to the above process

If you would like to see how we use your personal data please read our privacy notice at:

www.surreycc.gov.uk/your-council/your-privacy/our-privacy-notices/children-schools-and-families

I give my consent for my information to be used in accordance with the privacy notice above. *

I consent to the information regarding my registration status as a chaperone, being shared with other local authorities, Producers and Production Organisations in relation to applications made under S37 Children and Young Persons Act 1963 *

Which Surrey Borough do you live in? *

If your local Borough is not listed, please contact your local borough for more information

Title *

First Name *

Surname *

Please list any other names you have been known by (if you have only been known by the above name, please put none) *

Date of Birth *

Email *

Address line 1 *

Address line 2

Town *

County

Postcode *

Daytime Telephone No.

Mobile Telephone No. *

Please state the number and ages of your own children (If you do not have any children please put none) *

Please state any experience you have in caring for children *

Does your past or present employment involve regular contact with children or young people? If yes please give details *

Have you or members of your family had any involvement with Social Services? If so with which local authority and in what capacity? Any information given does not automatically preclude you from licensing and will remain confidential. Please note that all applicants will be researched on available databases, including those held by social care. *

Please name two referees (not family members/partners/partners family) who have known you for more than 2 years. They must know of your experience looking after children and your suitability to act as a chaperone. They must NOT know you solely in connection with your dancing school or amateur dramatic organisation.

I confirm that consent has been obtained from the following referees for Surrey County Council Child Employment Team to contact them on my behalf. *

Reference 1) Title *

Name *

Address *

Postcode *

Email Address *

Telephone Number *

Context in which known *

Period known *

Reference 2) Title *

Name *

Address *

Postcode *

Email Address *

Telephone Number *

Context in which known *

Period known *

Name and location of the first production you wish to chaperone for (including dates if known)

Chaperones will have regular contact with children so this role is exempt from the Rehabilitation of Offenders Act 1974. Therefore you are required to declare any convictions, cautions, bind-overs or prosecutions you may have, even if they would otherwise be regarded as 'spent'under this Act.

Have you ever been convicted of any criminal offence? *

If YES, please specify the date of conviction, court, nature of offence and sentence imposed

Under the arrangements introduced for the protection of children, Surrey County Council will check with the Disclosure and Barring Service (DBS) for the existence and content of any criminal record. You will be required to complete a DBS form to enable an Enhanced check to be made.

If you are signed up to the DBS Update Service and have an enhanced children's workforce and children's barred list DBS check, if you provide permission we may be able to use this service instead of running a new DBS check. Please contact the Child Employment Team on 01483 517838 for further information.

Do you intend to work professionally as a chaperone, receiving payment other than expenses? *

All chaperones who are going to be paid on any occasion, other than out of pocket expenses, cannot be classed as a 'volunteer'. We must therefore make a Professional DBS check for you, which will incur an additional charge of £44 & £25 administration fee, i.e. an extra £69. This can be paid at the end of this form by Debit or Credit Card, alternatively it can be collected when you supply your DBS documents. If you already have a Professional DBS check on the update service and your DBS check meets our requirements, you may not need to pay this fee. Please call us to check before doing so.

When you apply for an Enhanced Disclosure and Barring Service (DBS) (Formerly CRB) check, please refer to the 'DBS Information and Accepted Documents List' which will be emailed to you on receipt of this chaperone application. We will need to see you and your documents which will be returned to you the same day. Copies of your documents are not acceptable.

Please make a payment of £40.00 now to cover the training and administration charge and if applicable, a payment of £69 for the professional DBS check. Once payment has been made, the Child Employment Team will get in touch by email regarding booking you onto convenient upcoming training sessions. If you have any queries you can contact us on 01483 517838 or chaperones@surreycc.gov.uk

Please make your selections
Item	Item cost	Amount
Total cost:
E-Suite Chaperone Training *	£40.00	£40.00
Professional DBS Check	£69.00	£0.00

Payment required

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Debit card
Credit card

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Updated: 23 Aug 2019
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