Ringwood Workshops 2025 Open Sign Up Form

Dance & Acrobatics - Ringwood Workshops

This form should be completed to sign up for the FREE Dance & Acrobatics workshops taking place this May & June 2025. If you have any access requirements and require this form in another format, or this form does not work for you, please email jolivyannproducer@gmail.com or call 07961 196567.

For anyone under the age of 18 taking part this form needs to be completed by a parent/carer. Please note the minimum age for participants is 14.

This form should take between 2 - 5 minutes to complete.

Greyfriars (Ebenezer Hall) Tues 20 May 7.15-8.45pm
Greyfriars (Ebenezer Hall) Tues 3rd June 7.15-8.45pm
Greyfriars (Ebenezer Hall) Tues 17th June 7.15-8.45pm

For further detail on how we store and use your data please visit: https://joli-vyann.com/privacy- policy
Participant's Full Name*
Participant's Pronouns
Contact Email address*
example@example.com
Contact Number*
Address*
Postcode*
Which class will you be taking part it? You can attend multiple sessions.*

20th May 20253rd June 202517th June 2025
Do you/the participant have a history of any of the following: Tick all that apply

DiabetesAsthmaStomach upsetsCardiovascular problemsOperationsEpilepsyAnaemiaOther
For safety, please inform us of any physical or mental health difficulties, medications, or treatments you/the participant has had or is currently undergoing.
Joli Vyann welcomes dancers with all forms of physical and sensory abilities and disabilities. Please tell us if you/the participant have a disability or neurodivergency, and if there are additional support needs to ensure you/ the participant can get the most out of the class. All information provided will be kept private.
Do you/ the participant have any allergies?
Do you/ the participant have an EpiPen or any other medication? If so, is there any information we should be aware of regarding medication while you/they are taking part?
For participants under 18
Parent/carer and emergency contact name
Parent/carer and emergency contact relationship
Parent/carer and emergency contact email address
example@example.com
Parent/carer and emergency contact phone number
Parent/carer contact address (if different to above)
IMPORTANT INFORMATION FOR PARENTS/CARERS OF PARTICIPANTS UNDER 18 Joli Vyann aims to provide a safe and enjoyable experience for every participant. • All questions on the consent form must be completed and signed by the parent or carer before anyone under 18 takes part. • Parents/carers must ensure they notify us of any changes to the information given on the form. • Parents/carers must make arrangements for children to be brought to and from the activity safely and on time. If a parent/carer is not able to collect their child, they need to let us know in advance who will be doing so. • We cannot take responsibility for any damaged clothing and/or personal items during the activity. • Parents and carers should ensure children have sufficient water, food, clothing, sun lotion and medication (where appropriate) for the duration of the activity. • I consent for the individual named above to participate in the class and will arrange for their drop-off and pick-up at the start and end of each class. If I am not able to collect the participant myself, I will let Joli Vyann know in advance who will be doing so. • The workshops are physical. Therefore, for safety and demonstration purposes, the intructor may need to touch the participant. The participant can let us know in the workshop if they prefer no contact. • The participant understands they can talk to Jan or Olivia during the workshop if they are not comfortable at any time so they can support them. •The participant agrees yo Joli Vyann keeping a record of this form so they have the information they need to keep the participant safe during the activity. • By ticking Yes - you give consent for individual named to take part in the Dance & Acrobatics free taster workshops at Greyfriars Community Centre.

YesNo
For everyone to complete
Occasionally we might photograph classes for our records and for future publicity, both printed and online. Do you give permission for Joli Vyann to use photographs or videos of you/ the participant for our website, social media and/or publicity material?*

YesNo
For reporting purposes, you/ the participant agrees to complete a paper evaluation form at the end of each class attended.*

YesNo
Is there any other information you would like to tell us?
Thank you for taking the time to complete this form. Please email jolivyannproducer@gmail.com if you have any questions.
Should be Empty:

For participants under 18

For everyone to complete

Thank you for taking the time to complete this form. Please email jolivyannproducer@gmail.com if you have any questions.