StarmakerZ
Childs Details
Name
*
Date of Birth
*
/
Day
/
Month
Year
Date
First Line of Address
*
Area
*
Town/City
*
Postcode
*
Next of Kin Details #1
Name
*
Phone Number
*
Format: 07000000000.
Email Address
*
example@example.com
Next of Kin Details #2
Name
Phone Number
Format: 07000000000.
Email Address
example@example.com
Do you consent to your child taking part in any video recording captured for our projects or to be used in any charity promotional videos?
*
Yes
No
Does your child have any medical requirements?
*
Yes
No
If yes please give details
Does your child have any Special Educational Needs (SEN)?
*
Yes
No
If yes please give details
Signature
*
Date
*
/
Day
/
Month
Year
Date
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