Application Form APPLICATION DETAILS CHILD’S FULL NAME: (required) CHILD’S AGE & D.O.B: (required) PARENT/GUARDIAN NAME AND RELATIONSHIP TO CHILD: (required) PARENT/GUARDIAN ADDRESS: (required)br /> CONTACT PHONE NUMBER 1: (required) CONTACT PHONE NUMBER 2: (required) EMAIL ADDRESS: (required) EMERGENCY CONTACT DETAILS NAME AND RELATIONSHIP TO CHILD: (required) CONTACT PHONE NUMBER 1: (required) DOES YOUR CHILD HAVE ANY MEDICAL/ALLERGIES/LEARNING NEEDS THAT YOU WOULD LIKE DDA TO BE AWARE OF? YES/NO IF YES, PLEASE GIVE DETAILS BELOW ANY OTHER COMMENTS: PLEASE NOTE ANY MEDICAL INFORMATION PROVIDED IS ONLY USED FOR THE PURPOSE OF ENSURING THAT THE APPROPRIATE ARRANGEMENTS ARE MADE TO ENABLE A CHILD TO PARTICIPATE IN CLASSES WITHOUT DANGER TO THEIR HEALTH, AND IN THE EVENT OF A MEDICAL EMERGENCY, TO BE PROVIDED TO THE EMERGENCY SERVICES WHICH DDA CLASS/CLASSES WOULD YOUR CHILD LIKE TO ATTEND: (PLEASE STATE IN THE COMMENTS) Debut Dance Club Crofton Anne Dale Juniors Years 3 – 6 Mondays 15:30 – 16:30 Diddi Debuts Ages 4 - 7 Thursday 16:00 - 17:00 Act 1 Musical Theatre Ages 4 – 7 Saturday 9:00-10:30 Act 2 Musical Theatre Ages 7-12 Saturday 10:30-12:00 CLASSES TO ATTEND AND ANY OTHER COMMENTS: DECLARATION: I the Parent/Legal Guardian of declare that the information in this application is correct and hereby apply for a place for my child at DEBUT DANCE ACADEMY. I agree to pay all fees by monthly subscription and understand that payment will be taken on the same date of purchase every month. Fees are based on a 37 week school year and have been divided into twelve equal payments from September to August. I understand that my child’s place at DDA cannot be guaranteed unless fees have been paid in full and DDA reserves the right to withdraw the place of the nominated child until payment has been received. Refunds will not be given for classes missed by the student. If in the event a DDA teacher is unable to take a scheduled class, the class will be rearranged where possible. If this is not possible, any pre-paid fees for that class will be refunded in full. Classes which fall on bank holidays will not be refunded and will be rescheduled where possible. I understand that DDA will not be held responsible for classes cancelled due to extreme circumstances and in this case, classes will be rearranged where possible. I understand that my child’s place at DDA is auto renewed and in order to cancel my child’s place I must give 4 weeks written notice to sofia@debutdance.co.uk in order to cancel any further payments, otherwise one further months payment will be taken. I understand that dancing is a physical skill and in order to facilitate the students’ learning, the teacher may use physical touch to guide a movement. This will always be in a professional manner and the intention of the contact will be made clear. I understand that the Safeguarding policy is available to view through the DDA website and I must make both myself and my nominated child aware of the Health and Safety Policies at DDA. I agree to notify the Principal of any change in contact details. I agree for my data to be used to notify parents/guardians of upcoming events, changes in terms or important information and understand that I can request to see any personal data DDA holds about myself/nominated child at any time. I understand that if I would not like to be contacted by phone or email, I must notify the principal. I understand that the full Data Protection Policy is available to view at www.debutdance.co.uk . I understand that DDA will not be held responsible for any items lost or stolen. Any items found will be kept in a lost property box with the principal. I understand that if these items are not claimed after a reasonable length of time, these items will be disposed of. I agree to drop students off and pick students up from directly outside the studio door and I understand that students will not be dismissed unless passed directly to a parent/guardian. I agree to inform the principal as to who is collecting my child. Any complaints or queries should be directed to the Principal only. DDA reserves the right to amend these terms at any time and will communicate any changes to you at the email address provided. (PLEASE SIGN BELOW TO AGREE CONSENT – YOU CAN WITHDRAW YOUR CONSENT AT ANY TIME) Parent/Guardian Name: Date: PHOTOGRAPHY PERMISSION: THE USE OF PHOTOGRAPHS IS AN IMPORTANT TOOL WHICH IS WIDELY USED IN SETTINGS FOR RECORDING, SHARING AND DISPLAYING ACTIVITIES THAT YOUR CHILDREN HAVE UNDERTAKEN AND MAY BE USED FOR MARKETING PURPOSES. AT DEBUT DANCE ACADEMY WE TAKE THE ISSUE OF CHILD PROTECTION VERY SERIOUSLY AND WE WOULD NEVER KNOWINGLY PUBLISH AN IMAGE OF YOUR CHILD WITHOUT YOUR CONSENT. AS THE PARENT/GUARDIAN OF THE CHILD NAMED ABOVE, I GRANT PERMISSION FOR IMAGES OF MY SON OR DAUGHTER TO BE USED FOR THE FOLLOWING PURPOSES: o ELECTRONIC AND PRINTED DISPLAYS (E.G. PHOTOS OF ACTIVITIES) o OBSERVATION AND ASSESSMENT OF MY CHILD’S PROGRESS o DDA’S OFFICIAL WEBSITE o DDA’S OFFICIAL SOCIAL MEDIA ACCOUNT o PROMOTIONAL MATERIAL (E.G. FLIER, ADVERT, POSTER) o LOCAL NEWSPAPER OR MAGAZINE o NATIONAL NEWSPAPER OR MAGAZINE o RECORDING OF SHOWS AND PERFORMANCES o RECORDING OF CLASS CONTENT o OTHER PERSONAL DETAILS OF ANY CHILD IN A PHOTOGRAPH WILL NEVER BE GIVEN IN SUCH A WAY THAT WOULD ALLOW THEM TO BE INDIVIDUALLY IDENTIFIED. I UNDERSTAND THAT THIS IMAGE WILL NOT BE USED FOR ANYTHING WHICH MAY BE VIEWED AS NEGATIVE IN TONE OR THAT MAY CAUSE OFFENCE, EMBARRASSMENT OR DISTRESS FOR THEIR CHILD OR PARENT/GUARDIAN. I UNDERSTAND THAT THERE WILL BE NO PAYMENT FOR MY CHILD’S PARTICIPATION. (PLEASE SIGN BELOW TO AGREE CONSENT – YOU CAN WITHDRAW YOUR CONSENT AT ANY TIME) Parent/Guardian Name: Date: 1+5=?
