Limepalm Workshops Registration Form

Limepalm Workshops Registration Form
Student & Parent/Carer Information
Child's First Name
Child's Surname
Parent / Carer's First Name
Parent / Carer's Surname
Parent / Carer's Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Carer's Email
example@example.com
Are there any other details you would like to share?
Additional Information
Child's Date of Birth

MonthDayYear
Date
Child's Age at Registration
School Year
Gender
First Language
Current Pre-School / School / College
Alternative Emergency Contact
Alternative Emergency Contact First Name
Alternative Emergency Contact Surname
Alternative Emergency Contact Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student
Medical Information
Child's Doctor
Surgery Address & Telephone Number for Child's Doctor
Does the child have any allergies, intolerances, medical conditions, special educational needs, or disabilities we should know about?
Consent
Permission to share medical information with authorised staff
Permission for emergency treatment
Permission to administer prescribed medication
Permission to use plasters
Permission to walk home alone
Marketing
Permission to take photographs for marketing purposes?
Parents/carers have permission to film presentations/performances but this is strictly for their personal use and MUST NOT be distributed or shared via any social media platform.
I have read and understood the filming notice above.
How did you hear about Limepalm Productions?
Code of Conduct
Limepalm Drama considers itself a big family, where everyone is accepted and heard. Limepalm Drama does not tolerate rude, offensive or aggressive remarks and behaviour in any way. Please ensure your child understands our code of behaviour.

If you have a complaint or concern please email us at info@limepalmproductions.com
I have read and understood the Code of Conduct and agree to follow it
Digital Signature
I confirm that I am the child’s parent/guardian or otherwise legally responsible for the child, and that the information provided in this form is correct to the best of my knowledge.
Tick to confirm the statement above
I have read and understood the Limepalm Ltd LAMDA Tuition Terms and Conditions and agree to adhere to all guidelines.
Tick to confirm the statement above
I have read and understood the Limepalm Ltd Payment Obligations Terms and Conditions and agree to adhere to all guidelines.
Tick to confirm the statement above
SIGNED (parent/guardian) — TITLE / FIRST NAME / SURNAME

First NameLast Name
Should be Empty:

Limepalm Workshops Registration Form

Student & Parent/Carer Information

Additional Information

Alternative Emergency Contact

Medical Information

Consent

Marketing

Code of Conduct

Digital Signature