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Inclusion projects referral form

Referral form

Please fill in the form below which will be sent to our Participation team. Alternatively you can contact us directly at participation@lyric.co.uk

START referral form

Please fill in the form below which will be sent to our Participation team. Alternatively you can contact us directly at participation@lyric.co.uk

"*" indicates required fields

Young person's details

MM slash DD slash YYYY

Details of referral agency

Eligibility

Is the young person any of the following? Please tick as many boxes as applicable.
Which West London borough does the young person currently live in?*

Reasons for referral to the Lyric Hammersmith Theatre

Summary of young person's details

MM slash DD slash YYYY
I confirm that the above information is correct to the best of my knowledge and that I am authorised to submit it*
This field is for validation purposes and should be left unchanged.