Young Person Registration

STARPIC PROJECT

Dance Registration Form

Dancer ONE*

First NameLast Name

Dancer ONE (D.O.B)*

Date

Dancer 1 (Gender)*

Gender at birth

Dancer 1 (Ethnicity)*

Dancer 1 (Safety)*

Dancer 1 (Education)*

Name of school/uni

Dancer 1 (Doctor)*

Dr's Practice Name

Dancer 1 (Medical)*

Any illness or disability.

Dancer 1 Classes*

Select class to attend

Dancer 1 Level*

Select current level

Dancer TWO

First NameLast Name

Dancer TWO (D.O.B)

Date

Dancer 2 (Gender)

Dancer 2 (Ethnicity)

Dancer 2 (Safety)

Dancer 1 (Education)

Name of school/uni

Dancer 2 (Doctor)

Dr's Practice Name

Dancer 2 (Medical)

Any illness or disability.

Dancer 2 Classes

Dancer 2 Level

Select current level

Media Consent*

We may use images/recording equipment for promotional online & SOCIAL MEDIA usage. Do you give consent to the use of photo/video within the project including internal communication by Places For People?

Outing Consent*

We plan in advance short journeys to perform as Starpic Project and attend events/performances. Do you give consent allowing the young person to attend with Starpic Project?

Emergency Medical*

I agree to the participant receiving emergency dental, medical or surgical treatment, including a blood transfusion and anaesthetic, as considered necessary by the medical authorities present. I understand reasonable attempts will be made to contact the emergency contact(s) before administering treatment. Any objections to the administration of blood products should contact Starpic Project via email.

How did you find out about Starpic Project?*

Facebook, school, flyer, friends name etc.

Parent E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

City

Postcode

Space for a message

Emergency 1 (Name)*

Emergency 1 (Phone)*

Emergency 1 (Kinship)*

2nd Contact (Name)*

2nd Contact (Phone)*

2nd (Kinship)*

GDPR

As part of our communications activity, Starpic Project and all Partnerships may occasionally uses digital images and video for publicity purposes. We would like your permission to digitally photograph/film the person in your care for possible inclusion in our publications, website, social media and other publicity material.

1. The image(s) will remain the property of Starpic Project or other partnership colaborators and will be used for the designated purpose of promoting their specific services, aims and values.

2. They may also be used by third parties, contractors and suppliers who have been approved by Starpic Project.
3. Permission cannot be withdrawn once images have been used in our publications and other publicity material.

The image(s) / film may be stored electronically for use by Starpic Project employees on request.

I give my permission for Starpic Project and and its subsidiaries/suppliers / contactors to use images or publications and publicity material including (but not limited to) its websites, social media channels, to share the image(s) with external publications such as local newspapers. You also give permission to be contacted via (email, text, WhatApp, letter).

Disclaimer

You are providing your contact details which we may use to inform you of any STARPIC activities. Should you wish to opt out please contact us through the website www.starpicprojet.co.uk.

NOTE

Each dancer must bring enought water to keep hydrated throught the class.
Any litter must be removed at the end of each session.
The coach will take a register and ONLY those of the register can attend.
Starpic Project take no responsability for damge / loss of personal property.

Keep Us Updated

Should any of the infomation you have completed change please ensure you inform us and complete a NEW registration form.

Message Box

Signature*