ICONIC Street Dance CONSENT / REGISTRATION FORM

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Anything written on this form will be held in confidence. Our instructors need to know these details in order to meet the specific needs of each student. Please note that this course is 6 weeks long which is reflected in the price. Please pay via our booking page: https://iconicstreetdance.com/product-category/classes/
Discount for multiple classes applies see our website here https://iconicstreetdance.com/full-programmes/
If any of these apply to you contact us for discount codes.

Email *

Date of Birth *

YYYY

Student Name *

Age *

Address (inc postcode) *

Lauren's ICONIC Legacy Classes - THURSDAYS

Intermediates (p4-p7) 5.15-6.00pm £30

Seniors (yr 8+) 6.00-7.00pm £35

TSHIRT SIZE: If your child is a new member of ICONIC they will receive a Tshirt for free, please select their Tshirt size here. If any current members would like a new Tshirt, please also select their Tshirt size here.

MEDICAL CONDITIONS: Please indicate here if your child has any medical conditions that would be important for us to know, for their safety and well being. *

Name of Emergency Contact *

Relationship to young person *

Phone Number *

Name of Alternate Emergency Contact *

Relationship to young person *

Phone Number *

Declaration (if applicant is under 18 this must be signed by parent/guardian): I have read and accept the Terms and Conditions stated below and commit to a full term at ICONIC Street Dance. I will inform the instructions of ICONIC of any important changes to my or my child's health, medication or needs. In the event of illness, having parental responsibility for the above named child, I give permission for medical treatment to be administered where considered necessary by a nominated first aider or by suitably qualified medical practitioners. If I cannot be contacted and my child should require emergency hospital treatment I authorise a qualified medical practitioner to provide emergency treatment or medication. Please write below yes or no. *

Date Signed *

YYYY

I give explicit consent for the above named student to be photographed and/or videoed during ICONIC classes or events for promotional purposes at ICONIC? (which may be used on facebook, instagram, our website, youtube etc). Please write yes or no below. *

I give explicit consent for ICONIC Street Dance to file my information on their database. Please write yes or no below. *

I give explicit consent for ICONIC Street Dance to use my information for regular important class updates. Please write yes or no below. *

I give explicit consent for ICONIC Street Dance to use my information for future marketing purposes. Please write yes or no below. *

I have completed payment via the online booking page *

Yes

Date Completed *

YYYY

Send me a copy of my responses.

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