Dance Camp Registration Form

Nutcracker Dance Workshop

Saturday 21st December 2024
REGISTRATION FORM
Student name

First NameLast Name
Date of birth
Gender
Address

Address line 1

Address Line 2

TownCounty

Post code
Home Phone Number

Area CodePhone Number
Parent or guardian's mobile number
Parents or Guardian's Email
example@example.com
Student's current school class details
example: Bishopsgate 2M
Any important medical/ health/ allergy details we should be aware of? Please note we may give the children chocolate & sweets as prizes so if there are any dietary requirements please note them here.
Any special educational needs and/or disability we should be aware of?
Any other important information you would like to share?
Please specify which day/s of the camp you would like your child to attend
example: 21st December 24
Parent's or Guardian's name
PLEASE PRINT
Emergency contact details for student
example: Mrs Susy Susyballet, Aunt, phone number...
I give permission for Susyballet dance camp staff to administer first aid to my child. Please enter YES or NO in box
I give permission for photo and /or video footage taken of my child during the course of the Dance Camp to be used on Susyballet social media accounts, website and for other advertising purposes (such as but not limited to: flyers, banners etc..) Please enter YES or NO in box.
I give permission for photos and/or video footage taken during the course of the Dance Camp which feature my child to be released to other parents/guardians of children who have attended the dance camp as a memento. Please enter YES or NO in box.
I give permission for photo and/or video footage of my child taken during the course of the Dance Camp to be used for choreography purposes and to be shared between Susyballet staff and students as appropriate. Please enter YES or NO in the box.
I agree that if I take any photos or video footage of any dance demonstrations at the Dance Camp which may feature other Parents/ adults/ children, that it will only be used for my own purposes and I will not publish or share any images on social media or elsewhere without first obtaining appropriate adult consent. Please enter YES or NO in the box.
Name of person/people who will be collecting my child from the Dance Camp and their contact details (e.g mobile)
I agree and understand that in order to deliver safe dance practice, it may be necessary to use physical touch to explain correct dance movements or to assist in effective dance teaching.
I give permission for my child to participate in Susyballet's Dance Camp
I have read and agree to the Susyballet Terms and Conditions statement (where it applies to the Dance Camp)
I have read and agree to the Susyballet GDPR Policy (where it applies to the Dance Camp)
I have read and agree to the Susyballet Safeguarding policy (where it applies to the Dance Camp)
I understand and agree that in order to administer first aid, it may be necessary for staff at Susyballet Dance Camp to use physical touch. Appropriate PPE will be worn in the event of having to administer first aid.
I agree to my address and/or email being used for any mailings relating to Susyballet including invoicing information, news and updates.
I will provide my child with a nut free packed lunch for each day of the Dance Camp with their name clearly labelled on any containers.
I agree to inform Susy Morley in writing as soon as possible if there are any changes to the person authorised to collect my child and I will send this information through in good time during the dance camp days.
Please kindly note that in order for your child's place to be secured, the fee of £45.00 per child,per day, must be paid in advance of the Dance Camp. Places will be secured on a first come first served basis on completion of this registration form and received payment. Full refunds for any bookings will only possible until 13/12/24. After this date there will be a £25.00 per child cancellation fee taken off any refunds given. Please transfer the fee/s to the Susyballet business account. Details are as follows:- Account name:Susyballet / Account number: 42622259 / Sort code: 09-01-29. Please use your child's first and last name as reference.
Signed
Name (Please Print)
Date
Susyballet Office contact: 07555721370
Susyballet email: susy@susyballet.co.uk
Should be Empty:

Nutcracker Dance Workshop

REGISTRATION FORM