UPCOMING SHOWS! Be Our Guest - Sunday 21st Jan at 3:00pm | New Year Café Concert - Sunday 28th January at 3:00pm | The Jive Aces: Jump, Jive & Wail - Friday 9th February at 7:30pm

APPLICATION FORM

YOUR DETAILS

First Name:

Surname:

Address / Postcode:

Email:

Phone Number:

Work Number:

CHILD DETAILS

First Name:

Surname:

Gender:

DOB:

Age:

School Year:

EMERGENCY CONTACTS

Primary Emergency Contact

Contacts First Name:

Contacts Surname:

Contacts Number:

Contacts Email:

Secondary Emergency Contact

Contacts First Name:

Contacts Surname:

Contacts Number:

Contacts Email:

MEDICAL INFORMATION

Hospital/Clinic name:

Doctor's name:

Contacts Number:

Contacts Email:

Known medical conditions:

Allergies:

Current Medications:

PHOTOGRAPHY PERMISSION

Please tick the correct box

give permission for performance photographs of my son/daughter to be displayed on the group (private) facebook page or in the press.