LAR Brixton - Student Registration Form

Student Information

Child's Name

First Name Last Name

Date of Birth

Month Day Year

Class/es

Street Dance club (Tuesdays) Performing Arts club (Wednesdays) Drama club (Thursdays) Performing Arts (Thursdays)

Do you require collection from Corpus Christi School?

Yes No

Parent/Guardian Information

Name

First Name Last Name

E-mail

Emergency Information

Emergency Contact's Name

First Name Last Name

Phone Number

Any medical conditions/allergies/disabilities or anything else we should be aware of?

Do you give us permission to administer basic first aid if needed?

Informed Consent and Acknowledgement

I understand that by signing my child up for a class, I am automatically subscribed to the mailing list and can unsubscribe at any time.
Photos or Short Videos may be taken during class times and performances and may be used for promotional or marketing purposes and for LAR's Instagram or Facebook Page. If you would like your child withdrawn from this clause, please inform Louisa Alice-Rose in writing by emailing larperformingarts@gmail.com
I agree to all terms and conditions listed on the website - www.larperformingarts.co.uk/terms-and-conditions

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.