Jigsaw Youth Dance Company registration form

Registration details

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* 1. Young Person's Full Name (as it should appear in a programme)

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* 2. Date of birth

Date / Time

Date

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* 3. Address

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* 4. Town

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* 5. Postcode

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* 6. School Attended

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* 7. Parent/Guardian's Full Name

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* 8. Relationship to Young Person

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* 9. Home Tel Number

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* 10. Mobile Tel Number

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* 11. Email address

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* 12. Alternative Emergency Contact Name (this person will be contacted if we cannot get hold of the above in an emergency)

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* 13. Relationship to Young Person

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* 14. Tel Number

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* 15. Are there any access needs we may need to be aware of? (e.g. mobility)

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* 16. Is there anything we can do to support the young person's participation?

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* 17. Are there any medical conditions we may need to be aware of? (e.g. allergies, any regular medication taken)

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* 18. Please tick the boxes if you DO NOT consent to the following:

You give us permission to administer First Aid

You give us permission to produce recordings including photographs during Jigsaw Youth Dance activity for Wiltshire Creative marketing including online and social media

You give permission for limited physical contact with fellow participants and project leaders which can be involved in Jogsaw Dance activity

You give us permission to contact you regarding various activities and opportunities for the Young Person including specialist workshops, auditions and ticket discounts

You give permission for the Young Person (16 and over only) to leave unaccompanied at the end of the session

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* 19. You acknowledge that it is the parent/guardian's responsibility to update Wiltshire Creative with any change in contact details

Yes

Thank you for completing the Jigsaw Youth Dance Company registration form.

The Take Part team will be in contact with you shortly.