October 2-Day Intensive 2024
28th & 29th October 2024 at Elmhurst Ballet School.
Student Information
Student Name
*
First Name
Last Name
Date of Birth
*
DD/MM/YYYY
Age on 28th October 2024
*
Email Address (Parent/Guardian or 18+ Student)
*
Mobile Number (Parent/Guardian or 18+ Student)
*
Upload student headshot for ID purposes
*
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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.
*
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?
*
Yes, I give my permission.
No, I do not give my permission.
MTB photographers may take photographs of me/my child during the intensive 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 10 and 13 yrs old, please select which group you would feel most comfortable with:
*
Age 7-10 yrs
Age 10-13 yrs
Age 13-21 yrs
Medical Information
Is there any medical information/allergies that we need to know about?
*
Do you require any emergency medication (e.g. Epipen / Inhaler)?
*
If an emergency occurs I/we give permission for a Midland Theatre Ballet representative to take the applicant to hospital
*
Yes, I give my permission.
1st Emergency Contact Name
*
First Name
Last Name
1st Emergency Contact Phone Number
*
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.
*
I have read, understood, and accepted the privacy policy for MTB.
Parent Signature / or Student 18+ Signature
*
Optional Exclusive T-shirt
Please note: T-shirt will not be processed unless payment is made below
If you wish to purchase a 'MTB Exclusive October Intensive 2024 T-shirt', please select your child's size below and select the product below to make payment
Please Select
Age 5-6
Age 7-8
Age 9-11
Age 12-13
Adult Small
Adult Medium
Adult Large
Adult X-Large
Course Fee
*
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MTB 2-day Mon & Tues - £120
Non-refundable.
£
120.00
Quantity
1
2
3
4
5
6
7
8
9
10
Monday 28th October (One Day) - £65
Non-refundable.
£
65.00
Tuesday 29th October (One Day) - £65
Non-refundable.
£
65.00
[Optional] MTB October Intensive 2024 T-shirt (Natural Colour)
Heavy cotton T-shirt.
£
18.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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