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 OK Question Title * 1. Name of child/young person participating in the programme OK Question Title * 2. Name and contact details of child/young person's parent/carer Name Email Address Telephone Number OK Question Title * 3. Date of birth of child/young person participating in the programme OK Question Title * 4. Gender of child/young person participating in the programme? Female Male Prefer not to say OK Question Title * 5. Has the child/young person participating in the programme ever taken part in any dance classes before? Yes No OK The following questions are aimed at the child/young person participating in the programme OK Question Title * 6. Do you think our sessions will make you feel.... Energised Motivated Happy Sad OK Question Title * 7. Do you think you will enjoy our sessions? Yes No OK Question Title * 8. On a scale of 1 - 5 with 1 being the lowest and 5 being the highest, how would you rate your confidence? 1 2 3 4 5 OK Question Title * 9. Would you consider being part of a young person's forum that helps us decided how our sessions are delivered? Yes No OK Question Title * 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) OK DONE