IRIE! dance theatre's online Children and Young People's programme

This registration form is for online Children and Young People's programme

Please complete this registration form for EACH participant of the Young People's Programme

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* 1. Name of child/young person participating in the programme

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* 2. Name and contact details of child/young person's parent/carer

Name

Email Address

Telephone Number

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* 3. Date of birth of child/young person participating in the programme

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* 4. Gender of child/young person participating in the programme?

Female

Male

Prefer not to say

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* 5. Has the child/young person participating in the programme ever taken part in any dance classes before?

Yes

The following questions are aimed at the child/young person participating in the programme

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* 6. Do you think our sessions will make you feel....

Energised

Motivated

Happy

Sad

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* 7. Do you think you will enjoy our sessions?

Yes

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* 8. On a scale of 1 - 5 with 1 being the lowest and 5 being the highest, how would you rate your confidence?

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* 9. Would you consider being part of a young person's forum that helps us decided how our sessions are delivered?

Yes

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* 10. Which race/ethnicity best describes you? (Please choose only one.)

Asian or Asian British – Indian

Asian or Asian British – Other

Black or Black British – African

Black or Black British – Caribbean

Black or Black British – Other

Chinese

Mixed - Other

Mixed – White and Asian

Mixed – White and Black African

Mixed – White and Black Caribbean

White – British

White – Irish

White – Other

Prefer not to say

Another race or ethnicity (please specify)