Ballyhoo Dance and Theatre School: Registration Form

Confidentiality: Details on this form will be held securely and will only be shared with other members of Ballyhoo staff or others who need this information to meet the specific needs of your child
Personal information: Child/young person
Full Name
Preferred name if have one
Your Address
Date of Birth
Gender

Other
Are there any activities in which your child can NOT participate?
If yes, give details:
Does your child have an ISTD PIN number? If yes, please enter
Personal information: Parent/carer
Name
Contact number(s)
Email
Emergency contact information:
Name of alternative adult to contact in an emergency:
Relationship to child/young person:
Number of alternative adult:
Medical information:
Are there any specific medical conditions requiring medical treatment?
If yes, give details:
Details of medication required:
Are there any other medical conditions or disabilities to be aware of?
If yes, give details:
Do they have allergies?
If yes, give details:
Confirmation
Print Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Declaration of consent - parent/carer

Please tick boxes below and then sign this form
With your permission any photos or video will be stored on a computer or other external devices that Ballyhoo use . You have the right to change your previous consent to photos/ videos being taken, stored or used. Please inform Julie/Heidi/ Jane as they will be deleted as appropriate.
Are you happy to receive emails and communication keeping you up to date with Ballyhoo news, classes and courses that may be of interest to you ?
Signature
Print Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: