MOXIE ARTISTS

Artist Information & Screening Form
ART THROUGH ENDLESS MOTION

•MOXIE ARTISTS •
Title *
Name*

First NameLast Name
Address*

Address

Street Address Line 2

TownState / Province

Postal / Zip Code
City*
Post Code*
Mobile No.*
Work Tel No.
Email
example@example.com
Date Of Birth*

MonthDayYear
Date
Age (Years)*
Academic Year Group
Occupation
Please select any dance/ all vocational programmes that you wish to undertake.

Ballet (includes options for additional RAD & ISTD Syllabus classes)Jazz (includes Technical Jazz)Commercial DanceJumps, Kicks & Pirroutes (JKP)Contemporary (includes Lyrical dance)Hip-hopTapStrengthen & Stretch (Mandatory weekly conditioning sessions)Drama (includes options for private Acting tuition)Singing (includes options for private Singing tuition)Industry Workshops (coaching by Industry Stars & Professionals from Theatre, TV and more…)Spotlight Programme (Personal Development through Private Coaching in Dance, Acting & Singing)
MEMBERSHIP DETAILS
Membership Fee: £110 per month
- Consisting of 3 hours training per week in Jazz, Ballet & Commercial Dance
- ONLINE - complementary conditioning class per week (free of charge)
- Preparation for performance opportunities
(All fee's to be paid in advance)
*All additional disciplines and programmes are subject to additional fees
MEDICAL HISTORY
Do you or have you ever suffered from any of the following medical conditions? Check which ever item or items that applies to you, otherwise leave it unchecked.

Heart ConditionDiabetesAnaemiaHigh Blood PressureHigh CholesterolMigraineLow Blood PressureLung ConditionKidney or Urinary ProblemsAnginaEpilepsyBack ProblemsNeck ProblemsArthritis
Has your Doctor G.P has ever advised you against exercise or physical activities?

YESNO
If you are currently under any medication, please specify below:
ACTIVITY TYPE*
Describe how active your days are…
AIMS & GOALS
Tell us, what do you intend to achieve from yourself and your programme?
PERFORMING & TRAINING EXPERIENCES
We are committed to each individuals journey and would like you to share any/ all performing arts training experiences or performance opportunities, you have undertaken to date.
CONSULT YOUR GP OR DOCTOR FIRST
Before commencing on a program of physical exercises, you are strongly advised to consult your GP or Doctor in order to ensure that there are no contra-indicators.
DECLARATION
I hereby acknowledge that I have completed this questionnaire truly and whilst I am aware that all care will be taken by my coaches, any exercise undertaken will be fully explained and supervised by my coaches, I understand that any exercise prescribed will be taken at my own risk. I agree to waive all legal recourse (other than negligence) for damages to myself arising from participation. I also agree to abide by the direction and advice of my coaches. I also undertake to inform my coaches should there be any changes in my medical background/Condition.

By checking the box you are agreeing to the declaration and the terms and conditions of the Moxie Artists.
Full name of signatory*
Date of Signatory*

MonthDayYear
Date
If you have any performance or dance footage for review, please email any ditgial drive link back to "moxieartists21@gmail.com" with your full name as the subject.
Please upload the following for your Artist ID & Portfolio:

1. Passport size photo 2. (If applicable) If you have a portfolio or resume, please free to share
File Upload

Cancelof
Membership ID
For officers use only
Title*
Name*

First NameLast Name
Should be Empty:

Artist Information & Screening Form

MEMBERSHIP DETAILS

Membership Fee: £110 per month

MEDICAL HISTORY

AIMS & GOALS

PERFORMING & TRAINING EXPERIENCES

CONSULT YOUR GP OR DOCTOR FIRST

DECLARATION

Please upload the following for your Artist ID & Portfolio: