MTB Cinderella 15th August Workshop
Friday 15th August at Fabric, Birmingham Hippodrome, B5 4TB
Student Information
Student Name
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First Name
Last Name
Date of Birth
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DD/MM/YYYY
Age on 15th August 2025
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Email Address (Parent/Guardian or 18+ Student)
*
Mobile Number (Parent/Guardian or 18+ Student)
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Home Telephone Number
*
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.
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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?
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Yes, I give my permission.
No, I do not give my permission.
MTB photographers may take photographs of me/my child during the programme which may be posted online (e.g. social media).
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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:
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Age 7-10yrs
Age 10-13yrs
Age 13-21yrs
Medical Information
Is there any medical information/allergies that we need to know about?
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Do you require any emergency medication (e.g. Epipen / Inhaler)?
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If an emergency occurs I/we give permission for a Midland Theatre Ballet representative to take the applicant to hospital
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Yes, I give my permission.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
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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.
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I have read, understood, and accepted the privacy policy for MTB.
Parent Signature / or Student 18+ Signature
*
Course Fee
*
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( X )
7YRS - 9YRS: 10:30am - 12:00pm
Non-refundable.
£
15.00
10YRS - 13YRS: 12:30am - 2:00pm
Non-refundable.
£
15.00
13YRS - 21YRS: 2:30pm - 4:00pm
Non-refundable.
£
15.00
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