Sign up form for classes & projects
Thanks for signing up to a Your Next Move class or project. Information you provide is kept safe and confidential. A parent / guardian must complete the form for under 18 year olds. If you need assistance to complete this form, or require it in a different format, please contact Tyler: tyler@yournextmove.org.uk / 07842 591542.
PARTICIPANT INFORMATION
Your child's name (the person who will be attending the class/project)
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
County
Postcode
Your child's date of birth
*
-
Month
-
Day
Year
Date
Your child's age (at the time of completing/updating this form)
*
Email (parent if under 18)
*
example@example.com
Phone Number (parent if under 18)
*
-
Area Code
Phone Number
Your child's ethnicity (for monitoring & evaluation purposes, this information is kept confidential)
*
Your child's gender (for monitoring & evaluation purposes, this information is kept confidential)
*
EMERGENCY CONTACT INFORMATION
Name of emergency contact
*
First Name
Last Name
Relationship to your child
*
Emergency contact telephone number
*
-
Area Code
Phone Number
MEDICAL INFORMATION
Doctor's name, surgery & telephone number
*
Are there any actions we may need to take or signs we should look out for to give you / your child support?
Does your child have a medical condition? Please tell us what we need to know to keep you/your child safe and well.
Is there anything you / your child might have a problem with during a class/project that would be useful for us to know? What should be do if there is a problem?
Is there anything we may need to know that might affect your / your child’s safety or that of other participants?
What should we do if there is a problem?
BEING SAFE, WELCOME AND ABLE TO TAKE PART
Does your child identify as disabled?
*
Yes
No
Please tell us about anything we need to know to enable your child to enjoy taking part in our classes / projects. This can include how we can ensure they feel included as well as access requirements during class.
Does your child face challenges with your / their mental health, for example, anxiety, depression, low esteem?
*
Yes
No
Please tell us any information you feel it would be helpful for us to know.
CLASS / PROJECT CHOICES
There are limited spaces in classes and projects so please book to secure your place. If you cannot make a class / wish to attend an extra class in future, just get in touch with us and we'll update your preferences.
Which classes/project would you like to attend?
*
Bright Nights Dance Workshop, Kings Square, age 8-16 (4:30-5:30pm)
Street Dance: Thursdays at Parry Hall, age 8-16, 5-5:45pm
Breaking: Tuesdays at Gloucester Guildhall, age 8-16, 5:30-6:15pm
Welcome to Hip Hop! 2nd June 2023, 1:30pm - 4:45pm (13-16yrs)
Welcome to Hip Hop! 2nd June 2023, 9:45am - 1pm (8-12yrs)
Pathways: Graffiti experience day (Weds 23rd Aug 2023)
Pathways: Street Dance Day (Tues 22nd Aug 2023)
Circus, calisthenics & street dance project: October 2021
What classes would you like your child to take part in?
*
Pop-Up Popping 6-week course: 20 May - 24 June
Breaking Foundations: Tuesdays at Gloucester Guildhall, 5:30-6:30pm. Drop-in / pay as you go option - £5 per class.
Breaking Foundations: Tuesdays at Gloucester Guildhall, 5:30-6:30pm. Term option - £50
Popping Pop-Up: Wednesdays at Gloucester Guildhall, 5:00-6:00pm. Drop-in / pay as you go option - £5 per class.
Popping Pop-Up: Wednesdays at Gloucester Guildhall, 5:00-6:00pm. 5 week programme - £20.
Hip Hop Foundations: Thursdays at Parry Hall, 4:30-5:10pm. Drop-in / pay as you go option - £4 per class.
Hip Hop Foundations: Thursdays at Parry Hall, 4:30-5:10pm. Term option - £40
YNM Collective: Thursdays at Parry Hall, 5:15-6:00pm. Drop-in / pay as you go option - £4 per class.
YNM Collective: Thursdays at Parry Hall, 5:15-6:00pm. Term option - £40
How would you like to pay? (Class combo discounts will be applied after sign up)
*
Termly: 1 payment (due w/c 28th April)
Termly: 2 payments (50% due w/c 28th April, 50% due w/c 2ndJune)
Drop in weekly: cash/BACS transfer
I’d like a bursary for reduced price
How did you find out about this class/project?
*
Your Next Move social media
Your Next Move website
At another Your Next Move event / directly from a member of the team
Gloucester Guildhall website / social media
From another community group/organisation
From another family
From a community leader
Unsure
Other
MEDIA CONSENT
We take photographs and video footage of participants taking part in classes & events for promotional, educational and funder reporting purposes. The images and filmed footage will be used by Your Next Move and may appear in our printed publications, in the media, in funder reports and/or on our website or social media platforms. To comply with the General Data Protection Regulation (GDPR), we need your permission before we use any images of participants.
May we use images and filmed footage of you/your child in printed publications, in the media, in funder reports, on our website and our social media platforms?
*
Yes
No
May we use images of your child in our printed promotional publications?
*
Yes
No
May we send out images of your child with our press releases?
*
Yes
No
May we use images/video that may include your child on our websites / online?
*
Yes
No
May we feature you in our promotional / educational videos?
*
Yes
No
May we use images/video of your child in our reports to funders?
*
Yes
No
COVID-19 GUIDELINES AND PROCEDURES
Please read the Your Next Move Covid-19 guidelines for in studio classes, which can be found at yournextmove.org.uk/classes. Please also read and accept the following statements.
I understand that I should not attend class / should not bring my child to class if I am displaying symptoms of Covid-19 (new & persistent cough, high temperature, loss / change to sense of smell or taste)
Tick to accept
I understand that I should not attend class / should not bring my child to class if I / they (or anyone in my/their household) have tested posted for Covid-19
Tick to accept
I have read and understood the Your Next Move Covid-19 guidelines for in studio classes.
Tick to accept
FORM SUBMISSION
Signature
*
Date form completed
*
-
Month
-
Day
Year
Date
Date form updated
-
Month
-
Day
Year
Date
Would you like your details to be added to our database so we can let you know about similar opportunities in the future? We also run events and deliver other Hip Hop activities such as DJing, Graffiti Writing, MCing.
Yes please
No thank you, I only want to be contacted about this class
Please verify that you are human
*
Submit
Should be Empty: