Splatter Dance SEN Class Registration Form
Parent/ Name
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First Name
Last Name
Relationship to child/ren
*
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
What is the best way to contact you if a session needs to be cancelled at short notice?
*
If a different adult will be bringing your child/ren please tell me their name and their relationship to your child/ren:
*
Please provide emergency contact details (name, relationship to child/ren, phone number) that are different to yours/the adult who will attend:
*
Please tell us your child/ren's first name/s, age/s and any information we may need to know e.g. additional needs, medical conditions or allergies. If you will be bringing more than one child, all of the children's details can be placed below.
*
Please tell us how you heard about our classes?
*
Photographic Consent - As part of Splatter Dance activities, photographs and film footage may be taken and used in a range of Splatter Dance publicity materials. This is for educational purposes or to help document what happens in our activities. It may include them being included in leaflets or brochures, on social media and on our website. To protect the identity of our participants, identifying features such as their names will never be used.
*
Rows
Yes
No
I agree that photos of my child/ren may be used for future Splatter Dance print materials (for example leaflets and brochures)
I agree that Splatter Dance can use photos and video footage of my child/ren on their website.
I agree that Splatter Dance can use photos and video footage of my child/ren on social media – Facebook, Twitter and Instagram.
Please note: A parent/carer must remain with their child/ren during their class.
Please verify that you are human
*
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