Clone of Kaarla Wirren Workshop IN-SCHOOL PROGRAM Enrolment Form

Southern Edge Arts

Kaarla Wirren Workshop - Fire Arts for 16 - 27 year olds
Number of Participants to Enrol
This enrolment is for Kaarla Wirren - FIRE ARTS
PARTICIPANT ENROLMENT DETAILS
Participant 1 Name*

First NameLast Name
Participant 1 Birth Date*

DayMonthYear
Participant's preferred pronouns

She/HerHe/HimThey/ThemPrefer not to sayOther
Relevant participant 1 Medical / Behavioural information
Workshops and the performance of Kaarla Wirren will be photographed and filmed. By participating in the project, you agree to allow Southern Edge Arts and its funders to use photographs and films of the project for evaluation and promotional purposes. These photos and film will be shared with you at no cost.*

I consent
Participant 1 Contact Details
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.

Participant 2 Name*

First NameLast Name
Participant 2 Birth Date*

DayMonthYear
Please indicate preferred pronouns of participant

She/HerHe/HimThey/ThemPrefer not to sayOther
Relevant participant 2 Medical / Behavioural information
Workshops and the performance of Kaarla Wirren will be photographed and filmed. By participating in the project, you agree to allow Southern Edge Arts and its funders to use photographs and films of the project for evaluation and promotional purposes. These photos and film will be shared with you at no cost.*

I consent
Participant 2 Contact Details

If same details as Participant 1 please indicate 'same as participant 1' in the option below
Are participant 2 contact details the same as participant 1?*

YesNo
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.

Participant 3 Name*

First NameLast Name
Participant 3 Birth Date*

DayMonthYear
Please indicate preferred pronouns of participant

She/HerHe/HimThey/ThemPrefer not to sayOther
Relevant participant 3 Medical / Behavioural information
Workshops and the performance of Kaarla Wirren will be photographed and filmed. By participating in the project, you agree to allow Southern Edge Arts and its funders to use photographs and films of the project for evaluation and promotional purposes. These photos and film will be shared with you at no cost.*

I consent
Participant 3 Contact Details
Are participant 3 contact details the same as participant 1?

YesNo
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.

Participant 4 Name*

First NameLast Name
Participant 4 Birth Date*

DayMonthYear
Please indicate preferred pronouns of participant

She/HerHe/HimThey/themPrefer not to sayOther
Relevant participant 4 Medical / Behavioural information
Workshops and the performance of Kaarla Wirren will be photographed and filmed. By participating in the project, you agree to allow Southern Edge Arts and its funders to use photographs and films of the project for evaluation and promotional purposes. These photos and film will be shared with you at no cost.*

I consent
Participant 4 Contact Details
Are participant 4 contact details the same as participant 1?

YesNo
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.

EMERGENCY CONTACT DETAILS
Parent / Guardian or Emergency Contact Details

For under 18, please provide Parent/ Guardian details. For 18yrs+ please provide Emergency Contact details
Parent Guardian or Emergency Contact Name*

First NameLast Name
Relationship to participant(s)*
Mobile Number*
E-mail*
example@example.com
Subscribe to the Southern Edge Arts email list.*

Yes pleaseNot at this time
SECONDARY PARENT / GUARDIAN OR EMERGENCY CONTACT
Secondary Parent Guardian or Emergency Contact Name

First NameLast Name
Relationship to participant(s)
Mobile Number
E-mail
example@example.com
Subscribe to the Southern Edge Arts email list.

Yes pleaseNot at this time

SEA MEMBERSHIP
SEA is a membership-based organisation. All members are required to pay a yearly membership fee and complete a membership form annually.

ANNUAL MEMBERSHIP FEE of $20 ($15 for additional family members) each calendar year is due at time of enrolment.

Southern Edge Arts (SEA) members are entitled to voting privileges at our Annual General Meeting each year. Parents/guardians may elect to vote on behalf of their minor. By signing up as a member of SEA you are agreeing to:

- Adhere to our Constitution (available to download on our website).

- Adhere to our member Code of Conduct and Policies.

- Your email address being added to our Newsletter database (you can unsubscribe at any time).

- Photos or video footage being taken of members and used on the SEA website, Youtube, Vimeo, Facebook and other third party websites to promote the work of SEA and our funding bodies unless opted out above.
In order for SEA to deliver culturally relevant and accessible programs, please indicate if you (or your child) identifies as:

Aboriginal and/or Torres Strait IslanderPerson from a culturally diverse backgroundPerson with additional needs to support your inclusion
To Sign Print Parent/Guardian Full Name or Your Name if 18+years*

First NameLast Name
Date Signed*

MonthDayYear
Date

KAARLA WIRREN FIRE ARTS WORKSHOPS ENROLMENT

All participants must be SEA Members for insurance purposes. All participants must be 16 - 27 years old

MEMBERSHIP PAYMENT AND ENROLMENTS

FIRST MEMBERSHIPto be paid each calendar year

$20.00AUD Quantity

ADDITIONAL FAMILY MEMBERSHIP

$15.00AUD Quantity

IN SCHOOL PROGRAM - DANCE & CIRCUS

$ FreeAUD Number of attendees

Donate to our Equipment Fund

$10.00AUD Quantity

Total

$0.00AUD

Southern Edge Arts