Create Dance Enrolment Form

Parent/Guardian Email: *

example@example.com

Parent/Guardian Name *

First Name Last Name

Parent/Guardian Phone Number *

Area Code Phone Number

*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Child's Name (Please leave blank if enquiring for adult classes) *

First Name Last Name

DOB *

Age (on date of enquiry)

Medical Notes

Emergency Contact Name *

First Name Last Name

Emergency Contact Number *

Area Code Phone Number

Which classes are you interested in? *

Star Movers Dance (Reception and Year 1) Mini Movers Dance (Pre-school) Junior Dance Age 5-8yrs Over 50's Movers Ballet Class Baby and Toddler Dance Spotlight Dance Age 9-14rs Senior Contemporary Jazz Age 14+ Adult Dance and Fitness

Photographic and Film Consent Policy

We often take photographs or video films to aid learning within class and for publicity purposes. These images and footage may be used for Create Dance and Theatre Arts marketing material. I understand Create Dance and Theatre Arts has three branches of Create Dance Wirral, Create Dance Liverpool and Create Dance Sheffield. The marketing material includes our Website, Public Adverts, Facebook page, Instagram and any other marketing material. We need your permission to enable us to do this.

I GIVE MY permission for Create Dance Wirral to film my son/daughter during Create Dance classes and allow Create Dance and Theatre Arts to use the photos or film footage for ALL Create Dance and Theatre Arts marketing. This includes printed publications, Create Dance Theatre Arts Website, Public Adverts, Facebook, Instagram and any other marketing material.

Parent/ Carer signature___________________________ Date: ____________

I DO NOT GIVE permission for Create Dance Wirral to film my son/daughter during Create Dance classes and allow Create Dance and Theatre Arts to use the photos or film footage for ALL Create Dance and Theatre Arts marketing. This includes printed publications, Create Dance Theatre Arts Website, Public Adverts, Facebook, Instagram and any other marketing material.

Parent/ Carer signature___________________________ Date: ____________

I understand that Create Dance Wirral will share my details with the NHS test and trace service if a Covid-19 case arises in my son/daughters group.

Parent/Carer signature___________________________ Date: ____________

Print Child’s Name_______________________________________________

Return the booking form to Hayley@createdancewirral.co.uk

Contact: 07812561412 www.createdancewirral.co.uk

Please read the Photographic and Consent Policy and indicate if you agree or do not agree. Parents need to complete for under 18's.

Yes I Agree No I Do Not Agree

Mailing List

Please tick this box if you would like to recieve newsletters and marketing from Create Dance only. We NEVER pass onto third parties.

How did you hear about us?

COVID-19 INFORMATION
Ensuring the health and safety of our students and staff is a top priority. All students are expected to behave in a manner that supports social distancing and general safety. I understand that dancers MUST NOT attend class if they show any signs of Covid-19. Risk assessments are upon request.

I have read the COVID-19 information and agree with the restrictions? *

I agree

Create dance and Theatre Arts- Sheffield Branch