Magpie Performers WORK SHOP FORM

Magpie Performers Work Shop @ GLC Ipswich, SUFFOLK

Any one from 8 - 18 years of age or still in full time education
Number of Children
Child Name*

First NameLast Name
2nd Child Name*

First NameLast Name
Childrens Address*

Street Address

Street Address Line 2

TownCounty

Postal Code
Child Date of Birth*

DayMonthYear
Date
2nd Child Date of Birth*

DayMonthYear
Date
Child School*
2nd Child School*
SECTION 2: PARENT / GUARDIAN CONTACT INFORMATION FOR ALL CHILDREN
Name of Parent / Guardian*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

TownCounty

Postal Code
Email*
example@example.com
Mobile Phone Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Relation To Children*
Please note that in the case of an emergency we will contact the adult named above using the contact numbers provided, if there is a 2nd person you would also like us to contact please provide us with their name, relationship to child, and contact number below.
2nd person you would also like us to contact please provide us with their name, relationship to child, and contact number *
SECTION 3: ADDITIONAL INFORMATION
ALL KNOWN ALLERGIES
Including non-performance related allergies e.g. Nuts
HEALTH ISSUES
Including any health conditions and medication or medical treatment
ADDITIONAL NEEDS
Including any disabilities or impairments, learning difficulties, communication difficulties etc.
WORK SHOP FEES*

SUMMER WORK SHOP £95.00 PER CHILDSUMMER WORKSHOP £180.00 FOR 2 CHILDREN ( This Child Must Be A Sibling)
PAYMENT METHOD BACS Details Magpie Performers | 20-16-12 | 23454568*

BACS***
For more information, please visit our website www.magpieperformers.co.uk

Times of attendance

Monday 9:30 - 3:30

Tuesday 9:30 - 3:30

Wednesday 9:30 - 3:30

Thursday 9:30 - 3:30

Friday 9:30 - 3:30

Saturday 9:00 - 6:30

Show Times Saturday 3rd August.

14:00 & 17:00

Please provide food and drinks for your child through out the day, (No Fizzy Drinks or Nuts allowed)
SECTION 5: PHOTO PERMISSION AND T-SHIRTS
PHOTOGRAPHY

As part of Magpie Performers, it will sometimes be necessary for members to be involved in photography and filming during rehearsals. Many of our shows will also be filmed and be available for members and friends to purchase.
PHOTO PERMISSION*
Magpie Performers to take photos and record my child,
2nd CHILD PHOTO PERMISSION*
Magpie Performers to take photos and record my child,
Name of Child*
I understand that these pictures may be used by Magpie Performers in various forms of publicity, this may include on websites and video.
2nd Name of Child*
I understand that these pictures may be used by Magpie Performers in various forms of publicity, this may include on websites and video.
SHIRTS*
Every member of Magpie Performers Work shop is entitled to a shirt with the society logo and name.
2nd CHILD SHIRT SIZE*
Every member of Magpie Performers Work shop is entitled to a shirt with the society logo and name.
Child One Previous musical theatre experience
Child Two Previous musical theatre experience
Child One, what would you prefer to do
Child Two, what would you prefer to do
Signed by

Clear
Print Name

First NameLast Name
Should be Empty:

Magpie Performers Work Shop @ GLC Ipswich, SUFFOLK