Creative Dance for Dancers with Additional Needs Enrolment Form

Yes! Enrol me on Creative Dance classes.

Please complete the form below to sign up.
Choose a class: *

Alton Tuesdays 1:30pm (over 25 years) Alton Tuesdays 5pm (3yrs + /SLD) Alton Tuesdays 5:30pm (6yrs + / MLD) Alton Tuesdays 6.15pm (14 - 24yrs) Basingstoke Tuesdays 10:30am (over 25yrs) Basingstoke Thursdays 5pm (3yrs + / SLD) Basingstoke Thursdays 5:30pm (7 + / MLD) Basingstoke Thursdays 6.15pm (14 - 24yrs)
Name of Participant *

First Name Last Name
Name of Participant 2

First Name Last Name
Name of Participant 3

First Name Last Name
Name of Parent/ Carer (if relevant)

First Name Last Name
Phone Number *

Phone Number
E-mail *
Participant's Address *

Street Address

Street Address Line 2

City County

Postcode
Emergency contact name, relationship to you and telephone number. *
Does the dancer need 1 to 1 support? *

yes no
Tell us about the dancer's disability/ needs, if it will help us to teach you better.
Health and Safety Policy
To keep safe in class, I agree to:
- Wear loose, comfortable clothing,
- Dance in trainers,
- Bring a drink to class,
- Join in with the warm up, to avoid injury,
- Tell the teacher about new and existing injuries/medical conditions (relevant to dance).
- Stop dancing if I feel unwell,
- Follow instructions to the best of my ability.
I agree to the health and safety policy *

Yes, I agree
Photography Policy
As part of Collective Motion Dance activities, photographs and film footage may be taken and used in a range of Collective Motion Dance materials.

These will be used for educational purposes, to document our activities and may be included on posters, social media and on our website.

To protect the identity of our participants, identifying features such as names will never be used.
You can use my photos and videos *

Yes, I agree you can use No, please don't use
Privacy Policy
*

I understand that the Collective Motion Dance will never share my contact information for commercial purposes. I may, however, be contacted by the class teachers about relevant Collective Motion Dance announcements and information.
Payment
Classes cost £4.50 (30mins) / £6.50 (60mins) per week.

If you haven't already, please pay via our website:

collectivemotiondance.com (card).

If you would like to pay via bank transfer or cash, please let Louisa know at:

louisa@collectivemotiondance.com
Where did you hear about us? *
Should be Empty:

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Yes! Enrol me on Creative Dance classes.

Health and Safety Policy

Photography Policy

Privacy Policy

Payment