Waiting List - Intake Form
Hello and welcome! We’re so glad you’re interested in joining one of our Opening Doors groups. To help us get to know you a little better and see whether we have a space that matches what you are looking for, please answer the questions below together with the person interested in joining Opening Doors. If anything is unclear, please feel free to get in touch with us. We look forward to learning more about you and will be in touch if we have an opportunity that could be a good match. With thanks, the Opening Doors Team
Maltese Option / Għażla bil-Malti
If you require the form in Maltese instead, please visit: https://form.jotform.com/252302225856352 / Jekk teħtieġ il-formola bil-Malti minflok, jekk jogħġbok żur: https://form.jotform.com/252302225856352
Member’s Details:
Name
*
First Name
Last Name
Date of Birth
*
Date / Month / Year
Contact Number
*
(+356) 00000000
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / ZIP Code
Primary Caregiver Details:
If not applicable to you, please skip.
Name
First Name
Last Name
Contact Number
(+356) 00000000
Email
example@example.com
Relation
For example: Mother / Father / Guardian
Is there anyone else you would like us to keep informed about Opening Doors sessions, performances and events?
Emergency Contact Person:
Name
*
First Name
Last Name
Contact Number
*
(+356) 00000000
Email
*
example@example.com
Relation
*
For example: Mother / Father / Guardian
Questions about the Member:
Do you have any condition/s that we should be aware of? And if so, what would you like us to know about the way it affects you and how we can support you?
Do you have any medical conditions that we should be aware of? And if so, what would you like us to know about the way it affects you and how we can support you?
Do you have any physical access or mobility needs?
Is there any other information about your access or support needs that is important for us to know?
What is the best way for us to communicate with you? (Maltese, English, Written, Visual, Spoken, Other).
What is your preferred way of communicating with us? (Maltese, English, Written, Visual, Spoken, Other).
About the Member and Opening Doors:
What Artistic Discipline are you interested in:
*
Music
Dance
Theatre
Ballet
Tell us about why you want to join Opening Doors?
*
Do you have past experiences with any of the arts or with Opening Doors?
*
Send us a short video (less than 1 minute) showing us your talents in action:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
How would you travel to our sessions?
*
I am able to arrive and leave on my own.
Someone will be dropping me off and picking me up.
Other
Attendance is very important to us. It impacts the member’s ability to progress in their artistic discipline, it helps the group to focus and build work together, it helps the teacher to deliver the session they planned.
*
I am able to commit to attending a weekly session.
I commit to being available when we have rehearsals and performances.
I cannot make these commitments.
Some final questions:
Would you like to sign up to our newsletter to receive information about Opening Doors?
*
Yes, please
No, thank you
Would you like to receive emails about third party opportunities (example: performances, workshops, etc…)
*
Yes, please
No, thank you
How did you hear about Opening Doors?
*
Is there anything else you would like us to know?
Please verify that you are human
*
Submit
Should be Empty: