SUSY BALLET REGISTRATION FORM

SUSYBALLET
Registration Form
STUDENT
NAME

First Name Last Name
ADDRESS

Address Line 1

Address Line 2

Address Line 3 County

Postcode
DATE OF BIRTH (required for students under 18)

Month Day Year
Date
GENDER
TELEPHONE/MOBILE NUMBER (IF APPLICABLE)
EMAIL (IF APPLICABLE)
example@example.com
CURRENT ACADEMIC SCHOOL (For students under 18. We may need this information to apply for performance licences)
ANY IMPORTANT MEDICAL/HEALTH/ CONDITIONS? PLEASE SPECIFY
ANY SPECIAL EDUCATIONAL NEEDS AND/OR DISABILITIES? PLEASE SPECIFY
ANY ADDITIONAL CARE & SUPPORT AND IF SO, WHO FROM? PLEASE PROVIDE FURTHER DETAILS
PLEASE DESCRIBE ANY PREVIOUS DANCE EXPERIENCE OF PROSPECTIVE STUDENT
WHICH CLASS/CLASSES WOULD YOU LIKE TO REGISTER FOR? PLEASE SPECIFY DAY AND TIME
PARENT/GUARDIAN DETAILS (IF APPLICABLE)
NAME

First Name Last Name
ADDRESS

Address Line 1

Address Line 2

Address Line 3 County

Postcode
TELEPHONE/MOBILE NUMBER (IF APPLICABLE)
EMAIL
example@example.com
EMERGENCY CONTACT DETAILS
NAME

First Name Last Name
RELATIONSHIP TO STUDENT
TELEPHONE/MOBILE NUMBER (IF APPLICABLE)
PLEASE GIVE US DETAILS OF PERSON RESPONSIBLE FOR PAYING THE FEES (IF DIFFERENT TO ABOVE)
NAME

First Name Last Name
ADDRESS

Address Line 1

Address Line 2

Address Line 3 County

Postcode
EMAIL
example@example.com
NAMES AND MOBILE NUMBERS OF ADULTS WHO WILL NORMALLY BE SUPERVISING STUDENTS DURING CLASS (FOR OUR NURSERY CLASS FOR CHILDREN AGED 4 AND UNDER) AND/OR COLLECTING STUDENTS (UNDER 18) FROM CLASS. August 2021 update: due to the Covid-19 outbreak, we regret that only one parent/guardian per child will be permitted to attend & supervise their child for the nursery class. For all other classes there will be no parents allowed to enter the premises to watch or supervise without the teacher's permission.
NAME

First Name Last Name
TELEPHONE/MOBILE NUMBER (IF APPLICABLE)
NAME

First Name Last Name
TELEPHONE/MOBILE NUMBER (IF APPLICABLE)
PLEASE STATE THE NAME OF THE PERSON WHOM YOU WOULD LIKE US TO COMMUNICATE WITH VIA EMAIL FOR ALL BUSINESS MATTERS RELATING TO SUSYBALLET (e.g Fees, uniform, classes, timetable etc)
NAME

First Name Last Name
I GIVE PERMISSION FOR MYSELF (IF APPLICABLE) AND/OR MY CHILD’S NAME TO BE MENTIONED IN SUSYBALLET ADVERTISING AND OTHER INFORMATION CAPACITIES (SUCH AS NEWSLETTERS/DANCE SHOW PROGRAMMES/EXAM TIMETABLES ETC PLEASE ENTER YES OR NO IN BOX
I GIVE PERMISSION FOR MYSELF (IF APPLICABLE) AND/OR MY CHILD’S PHOTO OR VIDEO FOOTAGE TO BE USED FOR ADVERTISING (SUCH AS FLYERS/BANNERS/WEBSITE/SOCIAL MEDIA ETC PLEASE ENTER YES OR NO IN BOX
I GIVE PERMISSION FOR THE RELEASE OF PHOTOS AND/OR VIDEO FOOTAGE OF MYSELF (IF APPLICABLE) AND/OR MY CHILD TO BE SOLD TO PARENTS/STUDENTS OF SUSYBALLET AS MEMENTOS OF SUSYBALLET WORKSHOPS, REHEARSALS, SHOWS AND OTHER EVENTS PERFORMED BY SUSYBALLET STUDENTS. PLEASE ENTER YES OR NO IN BOX
I GIVE PERMISSION FOR MYSELF (IF APPLICABLE) AND/OR MY CHILD’S PHOTO OR VIDEO FOOTAGE TO BE USED FOR COACHING AND CHOREOGRAPHY PURPOSES AND SHARED BETWEEN APPROPRIATE OTHER SUSYBALLET STUDENTS AND STAFF. PLEASE ENTER YES OR NO IN BOX
PRIVATE COACHING
SHOULD PRIVATE LESSONS BE BOOKED, IT IS NECESSARY TO OBTAIN PERMISSION TO TEACH ONE TO ONE IF A CHILD IS UNDER 18.
I GIVE PERMISSION FOR MY CHILD TO ATTEND PRIVATE LESSONS WITH SUSYBALLET AND I AGREE TO REMAIN WITHIN SIGHT AND HEARING OF MY CHILD DURING THE SESSION. PLEASE ENTER YES OR NO IN THE BOX. August 2021 update: Due to the Covid-19 outbreak, we regret that only one adult/parent will be allowed to enter the premises at this time.
I GIVE PERMISSION FOR SUSYBALLET TEACHERS AND STAFF TO ADMINISTER FIRST AID TO MYSELF (IF APPLICABLE) AND/OR MY CHILD. PLEASE ENTER YES OR NO IN BOX. August 2021 update: During the Covid-19 outbreak, physical contact will be kept to a minimum and appropriate PPE worn if social distancing cannot be maintained for any first aid procedures.
I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN SUSYBALLET CLASSES (WHERE APPLICABLE)
I HAVE READ AND AGREE TO THE SUSYBALLET TERMS AND CONDITIONS STATEMENT
I HAVE READ AND AGREE TO THE SUSYBALLET GDPR POLICY
I HAVE READ AND AGREE TO THE SUSYBALLET SAFEGUARDING POLICY

I UNDERSTAND AND AGREE THAT ON OCCASION, IN ORDER TO DELIVER SAFE DANCE TEACHING PRACTICE, IT MAY BE NECESSARY FOR TEACHERS AT SUSYBALLET TO USE PHYSICAL TOUCH TO EXPLAIN CORRECT ALIGNMENT OR ASSIST WITH EFFECTIVE TEACHING. August 2021 update: During the Covid-19 outbreak, there will be no physical touch used unless deemed absolutely essential.
I UNDERSTAND AND AGREE THAT IN ORDER TO COMFORT DISTRESSED YOUNG CHILDREN OR TO ADMINISTER FIRST AID, IT MAY BE NECESSARY FOR TEACHING STAFF TO USE APPROPRIATE PHYSICAL TOUCH. August 2021 update: During the Covid-19 outbreak, there will be no physical touch used unless absolutely necessary for a child's safety & well being.
I AGREE TO MY ADDRESS AND EMAIL BEING USED FOR ANY MAILINGS RELATING TO SUSYBALLET INCLUDING INVOICING INFORMATION, NEWS AND UPDATES
PLEASE COMPLETE THIS FORM AND RETURN TO SUSYBALLET WITH THE REGISTRATION FEE OF £20.00 (NON REFUNDABLE/ £15.00 FOR SECOND/THIRD CHILD). August 2020 update: During the Covid-19 outbreak, payments can only be accepted by bank transfer. Registration fee is only paid once upon joining school, however, if you leave and then re-register, it must be paid again.
PLEASE NOTE THAT TRIAL CLASSES FOR CHILDREN (FIRST CLASS ONLY AND BY ARRANGEMENT, ARE FREE)
PLEASE NOTE THAT TRIAL CLASSES FOR ADULTS ARE £5.00 PAYABLE IN CASH ON THE DAY. August 2020 update: During the Covid-19 outbreak, payments can only be made by bank transfer.
IF YOU DECIDE TO CONTINUE AFTER YOUR TRIAL CLASS THEN THE REMAINDER OF THE FULL TERMLY FEE IS PAYABLE IN ADVANCE.
ONLINE TEACHING
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE POLICY RELATING TO SUSYBALLET ONLINE TEACHING, I HAVE EXPLAINED THE APPROPRIATE RULES TO MY CHILD/CHILDREN (IN AN AGE APPROPRIATE WAY) AND I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN ACCORDANCE WITH THE ABOVE POLICY.
I GIVE PERMISSION FOR IMAGES GENERATED FROM ONLINE TEACHING (E.G. A SCREEN SHOT OF A GROUP CLASS ONLINE) TO BE USED FOR ANY SUSYBALLET MARKETING/ ADVERTISING PURPOSES (PLEASE NOTE ANY NAMES WILL BE REMOVED OR OBSCURED). Please write YES/NO in box below.
I AGREE TO NOT SHARE SIGN UP DETAILS (SUCH AS ZOOM EMAIL LINKS AND PASSWORDS) TO ONLINE CLASSES WITH FRIENDS, FAMILY AND ACQUAINTANCES WHO ARE NOT REGISTERED MEMBERS OF SUSYBALLET. THIS IS FOR THE SAFETY OF OUR STUDENTS.
COVID-19 HEALTH PLAN
I HAVE READ AND UNDERSTOOD THE RISK ASSESSMENT AND THE HEALTH PLAN PREPARED BY SUSYBALLET FOR USE DURING THE COVID-19 OUTBREAK, I HAVE EXPLAINED THE APPROPRIATE RULES AND PROCEDURES TO MY CHILD/CHILDREN, I AGREE TO FOLLOW THE GUIDELINES AND I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN ACCORDANCE WITH THE POLICY. I UNDERSTAND AND AGREE THAT SOME PERSONAL INFORMATION MAY HAVE TO BE SHARED FOR THE PURPOSES OF THE NHS TEST & TRACE PROGRAMME.
SIGNED

First Name Last Name
DATE
Should be Empty:

SUSYBALLET

Registration Form

STUDENT

PARENT/GUARDIAN DETAILS (IF APPLICABLE)

EMERGENCY CONTACT DETAILS

PRIVATE COACHING

ONLINE TEACHING