PACE Youth Arts -Saturday Registration Form

PACE Youth Arts -Saturday Registration Form

PACE Youth Arts

SATURDAY REGISTRATION FORM
- Student Information
  
  Please complete one form per student
- Students Full Name
  
  First NameLast Name
- Age
- Birth Date
  
  DayMonthYear
- Gender Identity
- Nationality
- Home Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Medical History
- Does the student suffer from any of the following?
- If YES please give details:
- Does the student suffer from any allergies?
- If YES please give details:
- Is the student currently on any medication or receiving any ongoing treatment?
- If YES please give details:
- Has the student ever suffered any serious physical injuries?
- If YES please give details:
- Does the student have any disabilities or additional learning needs?
- If YES please give details:
- Student Information Continued.
- Please specify which class you would like to attend
- Is there any other information that could enhance the students' experience which you would like to share
- If YES please give details:
- PACE Scholarship
- Would you like to be considered for a PACE Scholarship? *please note, if you select yes, then you will be required to provide proof of benefits in order to be considered for a free placement.
- If YES, then please select which government support you are currently receiving:
- If you selected "other" then please give more information below:
- Please upload your proof of benefits here, you can request this via www.gov.uk
  
  Cancelof
- Approved Parent/Carers
  
  Please list below and parents and/or carers that are approved to collect the student from PACE.
- Approved #1
- Full Name
  
  First NameLast Name
- Relationship to child:
- Mobile Telephone
- Approved #2
- Full Name
  
  First NameLast Name
- Relationship to child:
- Mobile Telephone
- Approved #3
- Full Name
  
  First NameLast Name
- Relationship to child:
- Mobile Telephone
- Emergency Contact #1
- Full Name
  
  First NameLast Name
- Relationship to child:
- Mobile Telephone
- Other Telephone:
- E-mail address
- Home address:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Emergency Contact #2
- Full Name
  
  First NameLast Name
- Relationship to child:
- Mobile Telephone
- Other Telephone:
- Email Address:
- Home address:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Parent/Guardian consent
  
  Photography
- In accordance with our child protection policy, we will not permit photographs, video or other images of young people to be taken without consent. If the child is under 16, consent must be obtained from a parent / carer.
  
  PACE will take all steps to ensure these images are used solely for the purposes for which they are intended. If you become aware that these images are being used inappropriately, please inform us immediately.
- Declaration of consent - parent / carer of child under 16
  
  Please fill in appropriately and then sign this form
- I give permission for my child’s photograph to be used within the club for display purposes.
- I give permission for my child’s photograph to be used within other printed publications.
- I give permission for my child’s photograph to be used on the club’s website.
- I give permission for my child’s photograph to be used on the club’s social media pages.
- I give permission for video of my child to be used on the club’s website.
- I give permission for video of my child to be used on the club’s social media pages.
- I give permission for video of my child to be used for training or analysis purposes.
- Name of Child
- Name of Parent/Guardian
- Signature of Parent/Guardian
- Today's Date
  
  DayMonthYear
- Parental Agreement
- PACE aims to provide a safe and enjoyable experience for every child or young person.
  
  To help us do this, please note the following important information.
  
  • All questions on the consent form must be completed and signed by the parent
  
  or carer before any child takes part.
  
  • By signing the agreement, parents and carers are agreeing to pay all agreed fees to PACE Youth Arts prior to the child taking part. Failure to do so will result in the student losing their place in the programme.
  
  • Parents and carers must ensure they notify us of any changes to the information given on the form.
  
  • Parents and carers must make arrangements for children to be brought to and from the activity safely and on time. If a parent or carer is not able to collect their child, they need to let us know in advance who will be doing so.
  
  • We cannot take responsibility for any damaged clothing and/or personal items during the activity.
  
  • Parents and carers should ensure children have sufficient clothing, water and medication (where appropriate) for the duration of the activity.
- I agree to (please tick)
- I understand that my child needs to follow the behaviour code and any safety rules so that PACE can keep them and other children safe.
- Print Name of Parent/Guardian
- Signed Parent/Guardian
- Date
  
  DayMonthYear
- Student Agreement
- I agree to (please tick)
- I understand that enjoying the activity and being safe means I need to follow the
  
  behaviour code and safety rules.
- Print Name of Student
- Signed Student
- Date
  
  DayMonthYear
- Should be Empty: