Sound Stories Registration

ABOUT YOU
Young Person Full Name
Young Person Preferred Name
Young person date of birth (DD/MM/YY)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
School / College
Gender
Ethnicity
Food Allergies
Disability/Additional Needs?
Registered for free school meals?
More information Brief details of disability, additional needs or medical conditions. needs, or medical conditions.
If you have a safeguarding concern, please talk directly to Lucy Jackson, Safeguarding Lead on 07821686022
PARENT/GUARDIAN
If you are under 16 this must be the person who fills out the Parent/Guardian Agreement below.
Name of guardian/carer

First NameLast Name
Relationship
Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Email
example@example.com
ADDITIONAL EMERGENCY CONTACT
Name

First NameLast Name
Relationship
Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Email
example@example.com
Is your child allowed to leave the venue (i.e. to walk home) unattended?
I agree that my/my child's image/voice (in photos, videos or recorded music created in the sessions) may be used for marketing and publicity purposes in printed publications, on social media, on the Lips Inked Arts website or elsewhere.
Signature (Guardian/carer)
Should be Empty:

ABOUT YOU