Hoxton Hall October Half Term Dance Course 2019

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This October half term will be hosting a 3 day dance course incorporating dance and video, the session will be run by Jummee and his team from UMD bringing you the freshest moves of all time. The course will run from Monday 21st October - Wednesday 23rd October 10:30am - 3:30pm, please sign up below! We look forward to a fun filled few days.

Youth Arts Team

In order to ensure the safety of all of our participants this form must be completed fully by all parents/guardians. By filling out this form you give permission for the London Borough of Hackney Youth Service to collect and store personal data about me and the activities which I participate in for monitoring purposes. I understand the data will be held in line with the Data Protection Act 1998 and subsequent updates and amendments.

Please fill out one form per participant

Participant First Name *

Participant Sur Name *

Participant Age *

Age 7-10 Dance Worksop *

Yes

Required

Age 11-19 Dance Workshop

Yes

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Participant Gender *

Female

Male

Prefer not to say

Other:

Parent/Guardian Name *

Parent/Guardian Contact Number *

Medical Consent (Do you consent to trained Hoxton Hall staff giving first aid when necessary) *

Yes

Other:

I allow my child to go home from Hoxton Hall alone *

Yes

I allow my child to leave the Hoxton Hall building during lunch time *

Yes

I allow Hoxton Hall to take my child out oft eh building for relevant trips or lunch time park visits (weather permitting) *

Yes

I allow Hoxton Hall permission for my child's photo to be used in Hoxton Hall promotion *

Yes

Please give details of any relevant medical history *

Please give details of any relevant SEN information *

Contact email address (please ensure this is spelt correctly) *

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