Registration form

Which group/s would you like to register for:

Drama 4 Change (10 years +)Neuro Divergent (Centre Stage 16 - 25 years)Little Slippers (7-10 years)

Young Persons Name:

First NameLast Name

Young Persons E-mail (optional):

Young persons preferred gender pronouns

She / Her / HersHe / Him / HisThey / Them / TheirsOther

Young Persons Phone Number (optional)

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Birth Date:

MonthDayYear

Parent(s)/Guardian(s) details for anyone under the age of 18

Parent/Carer Name

First NameLast Name

Parent/Carer E-mail

example@example.com

Address (if different from above):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Carer Mobile Phone Number

Emergency Mobile Phone Number (Must be different to Parent/Carer Mobile Number. This is an alternative person that we can contact in an emergency if we cannot make contact with parent/carer)

Parent/Carer Home or other Phone Number

Area CodePhone Number

Please provide us with the name of the primary person who will be the main contact and person picking the young person up, if under the age of 16.

First NameLast Name

The name of anyone else who will pick the young person under the age of 16 up from the group.

First NameLast Name

If under 18 years of age a parent /carermust fill in any medical details.

Section 1: Medical Conditions/ Additional Requirements: If you answer yes to any of the questions below please tick the box and provide extra information in the box below. Please note that this information may be shared with others in the interest of your child's welfare. Any information provided will be treated as confidential in line with The Cracked Slipper Company confidentiality policy.

Do you/your child have any additional requirements e.g. physical disability, learning difficulties or literacy issuesDo you/your child have any medical conditions of which we should be aware of.Do you/your have any allergiesIs there any information we need to be aware of or that may have an impact on your child's participation with the Cracked Slipper Company workshops

If you have answered yes to any of the above in section 1, please provide further information.

Section 2: Consent:

For myself/my childs details in this form as provided to be processed in line with the purpose detailed in the privacy statement at the end of this form.Myself/my child to attend workshops.For photo/film footage of me/my child during workshop activities to be used for any publicity in relation to The Cracked Slipper Company workshopsFirst Aid/medical assistance to be sought in the case of an emergency.

Where did you hear about us?

I give permission for myself/my child to have their photo taken or be part of our filming for the sole purpose of The Cracked Slipper Company performances and promotion of events. This will be used on our website and social media platforms/ local paper only.

I give consent for myself/ my child's participation in The Cracked Slipper Company workshops

As part of the registration process we will respond with a welcome email which will include a welcome pack containing all of the information you will need about The Cracked Slipper Company. This includes important contact details. We do ask you to familiarise yourself with the welcome pack. As part of the welcome pack we do have a few rules, we do not like to set too many rules for particpation in our groups however we do expect the few rules we have to be adhered. We will set out our rules here and we ask you to sign to say you have read the rules and agree.

1. Our Rules:

At The Cracked Slipper Company we try not to have too many rules however our values are all about respecting one another.

Our Ethos is called CARE

C: Care about others and treat people like you would like to be treated yourself.

A: Always remember to be kind to one another.

R: Respect others and celebrate our differences.

E: Everyone matters

1. Attendance: We understand that there will be times of absence. We can only offer a certain number of places so therefore if a member of the group has more than 3 unauthorised absences, we do have the right to offer that place to somebody on the waiting list.

2. Behaviour

· Show respect for others: Our members will respect the rights and feelings of the other participants. Fighting, bullying, name calling, intimidations, bigotry of any kind, inappropriate language or any other form of emotional or physical abuse or unwanted contact directed to one another (participants), staff (including the staff at The Kindle Centre) or Volunteers will not be tolerated. (This includes any form of social media or group chats that are associated with CSC)

· Mobile phones must be switched off until there is a break, or the group has finished, members will make the most of the two-hour classes participating in the class and not distracting other members.

· Respecting the building and the facilities provided and remove any rubbish at the end of the group session.

· Dangerous Items: Never use drugs, alcohol, or carry any form of weapons of any kind they are not permitted in the building.

· Never Discriminate: Discrimination on the basis of race, colour, religion, gender, national origin, disability, or on any other basis prohibited by law, is never allowed in any form at The Cracked Slipper Company.

3. Attire: Dress Appropriately: Our members are expected to dress appropriately for class or any rehearsals except where otherwise guided by the Drama Leaders. Please do not wear clothing that depicts offensive slogans or images or any inappropriate revealing clothing. Please wear suitable footwear during all classes.

4. Arriving at group: You must arrive on time unless there is a good reason.

5. Leaving group to go home All members must leave the building promptly at the end of class and not hang around the building after group has finished. Members under the age of 14 years must be picked up by an appropriate adult named on the registration form. All belongings must be taken home.

6. The Cracked Slipper Company will: Provide a safe and positive environment to learn new skills and develop in confidence. Help every member explore their talents and abilities and help them to shine. Will equally respect all members and support them and their views. Provide highly motivating youth drama classes promoting equal opportunities and inclusion. Give young people the opportunity to have a voice and showcase their talents.

We want to make this a happy place for young people to attend and therefore if any young person who participates with The Cracked Slipper Company has any worries or concerns, they are encouraged to speak to one of the members of staff.

Please sign to say you have read our rules and that you agree with them.

Consent for the use of Personal Data:

The Cracked Slipper Company will use personal data only where consent to do so is affirmative, freely given, specific informed and unambiguous. The below privacy statement provides information on why we gather and how we use your personal data.

I have read, understood, and accepted the PRIVACY POLICY for Registration..

The Cracked Slipper Company Registration Form - Updated April 2025

The Cracked Slipper Company Privacy Policy