Child's Name *

First Name

Last Name

Does your child suffer from any injury/illness that you feel we should be aware of? *

YES

NO

In an emergency do you give permission for emergency treatment if required? *

YES

NO

Do you give permission for your child to leave unaccompanied from the venue? (Children over 12yrs only)

YES

NO

Do you give permission for your child to be escorted to the toilet by someone other than yourself or those listed above? (For our younger members)

YES

NO - I will be outside during the lesson to escort my child to the toilet

Are you happy for film & photographs to be taken in class and performances to be used for marketing and social media purposes? *

YES

NO

Information collected by this form will be held for a limited time in accordance with GDPR. From time to time LRSD would love to let you know about upcoming events, workshops, shows, competitions, offers and other school news. Full details on how we use data can be found in our privacy policy. I consent to having LRSD collect my name, phone number & email address. Please choose how you would like to stay in contact with LRSD * *

You will receive termly newsletters and other information such as new classes, holiday workshops and other opportunities for dancers.

EMAIL

TEXT

PHONE

I am aware I need to give 1 MONTHS WRITTEN NOTICE to stop classes. If you pay termly, you have committed to a term and no refunds or credits will be given. *

YES

Signature *

I Parent/Guardian of the member confirm that this Membership Agreement and any subsequent Membership entered into as a result is, and will be, subject exclusively to LRSD membership Terms and Conditions, a copy of which I acknowledge having received.

First Name

Last Name