Music Making Workshop
UCLan Media Factory, Kirkham Street Preston PR1 1JN.Friday 21st February 1:30-4:30pm
Young person name
First Name
Last Name
Date of birth
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Month
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Day
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Emergency contact name
First Name
Last Name
Relationship to young person
Emergency contact number
Email of emergency contact
example@example.com
Medical history and dietary requirements
Do you play an instrument? If so what?
I consent to the image of the young person named above to be used in any promotion of the event including marketing and social media.
Yes
No
Signature of parent/ guardian
Date signed
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Month
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Day
Year
Date
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