Rosanna Ely Masterclass
Saturday 6th January at BOA Academy (Birmingham).
Student Information
Student Name
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First Name
Last Name
Date of Birth
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DD/MM/YYYY
Age on 10th December 2023
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Email Address (Parent/Guardian or 18+ Student)
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Mobile Number (Parent/Guardian or 18+ Student)
*
Home Telephone Number
*
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Dance School
Name of Dance School
*
Name of Principle
*
All students must have full permission and support from their Dance Teacher to take part in Midland Theatre Ballet's programmes. Please do not complete this form unless you have spoken to your Dance Teacher.
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I confirm that I have full permission and support from my Dance Teacher to apply for this programme.
Programme Information
Can your child leave the studios unaccompanied after the session?
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Yes, I give my permission.
No, I do not give my permission.
MTB photographers may take photographs of me/my child during the masterclass which may be posted online (e.g. social media).
*
Yes, I give my permission.
No, I do not give my permission.
Please tick the group you are suited to. For those aged 13 yrs old, please select which group you would feel most comfortable with:
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Age 7-9yrs : 10:00am-12:00pm
Age 10-13yrs: 12:30pm-2:30pm
Age 13-21yrs: 2:45pm-4:45pm
Medical Information
Is there any medical information/allergies that we need to know about? (Please include any information regarding emergency medication, if required.
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If an emergency occurs I/we give permission for a Midland Theatre Ballet representative to take the applicant to hospital
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Yes, I give my permission.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
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2nd Emergency Contact Name
*
First Name
Last Name
2nd Emergency Contact Phone Number
*
Privacy Policy
Please read our Privacy Policy in order to understand how your information is used and shared, and check below if you accept the policy.
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I have read, understood, and accepted the privacy policy for MTB.
Parent Signature / or Student 18+ Signature
*
Workshop Fee
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£30 Rosanna Ely Workshop Fee
Non-refundable.
£
30.00
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