Creative Dance for Children Registration Form

Registration Form - Creative Dance For Children

Fill out the form carefully for registration
Class you child will attend (your child can only attend class appropriate for his/her age)*

Class 1 for 3-5 year olds on Fridays 4.00-4.45 pmClass 2 for 6-11 year olds on Fridays 5.00-6.00 pm
Child's Full Name *
Type your child 1st name followed by middle name followed by surname
Child's Name*

First NameLast Name
Parent's Name*

First NameLast Name
Parent's E-mail*

Confirmation Emailexample@example.com
Parent's Mobile Number*
PLEASE DO NOT TYPE COUNTRY CODE IF YOU HAVE UK NUMBER !
Child's Birth Date*

DayMonthYear
Child's Age*
Age Category (Westminster Council Categories)*

under 55-1011-18
Child's Gender *
Child's Address*

Street Address

Ward

CityBorough

Post Code
Ethnicity Categories (please note these are Westminster Council categories)*

AfricanCaribbeanAny other Black/African/Caribbean backgroundArabBangladeshiChineseIndianPakistaniAny other Asian backgroundWhiteIrishGypsy or Irish TravellerAny other WhitebackgroundWhite and AsianWhite and Black AfricanWhite and Black CaribbeanAny other Mixed/Multiple ethnic backgroundOtherUnknownPrefer not to answer
Religion Categories (please note these are Westminster Council categories)*

BuddhistChristianHinduJewishMuslimSikhNo religionUnknownPrefer not to answer
Child's Ethnicity*
Do you consider your child yo have disability or learning difficulty?*

YesNo
If Yes, please elaborate If No, type N/A*
Does your child have any health issues teachers should know about? *
If you child has attended our classes before, what class did she/he attend?

Class 1 for 3-5 year oldsClass 2 for 6-10 year olds
How would you rate the classes your child has attend with us in the past?

ExcellentVery GoodGoodAveragePoor
Where did you hear about us? *
Choose one*

FacebookInstagramWeb / Google searchWhatsApp groupFlyer from school/nurseryFound a flyer in the communityPoster on a noticeboardWord of MouthCoffee morning at a school/nurseryAn event / networking eventOther
Additional Comments
I give permission for photos or videos to be taken of my child during the classes/performances & to be used by Mala CHERGA Theatre and funders for publicity and website.

I knowingly, voluntarily and expressly waive any claim I may have against Mala CHERGA Theatre for injury or damages that my child may sustain as a result of participating in classes or workshops.
Signature*

Clear
IMPORTANT

When you submit your registration form you will receive an email from 'Jotform' with your registration form and a word document in the attachment entitled 'IMPORTANT INFORMATION AND ZOOM LINKS'. Please read this document carefully and save the zoom links for online classes.

We look forward to seeing you,

Mala CHERGA team
Mala CHERGA Theatre classes are funded by Westminster Council's Community Priorities Programme
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Registration Form - Creative Dance For Children

Mala CHERGA Theatre classes are funded by Westminster Council's Community Priorities Programme