Rock Banned! Booking Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

26th July – 6th August 2021
Dog Kennel Hill School, East Dulwich SE22 8AB

Email *

Child's Name *

Date of Birth *

YYYY

School Attended Currently

Parents/Carers Name *

Address

Contact Number *

Email Address *

Emergency Contact 1 *

Child's Relationship to Emergency Contact *

Emergency contact 1 Number *

Emergency Contact 2 *

Emergency Contact 2 Number *

Chil'ds Relationship to emergency Contact 2 *

Allergies and Medical Conditions

Additional comments

Please write here if you would like to let us know more about your child (e.g. particular aptitudes, emotional needs, likes etc.) and how you would like him or her to benefit from the workshop.

Payment *

The Holiday Course is offered on a Pay-What-You-Can basis, ranging from £20 to £390. This is so that we can offer the club as widely as possible. If you are able to meet the full costs, PLEASE don't claim a discount, we do have to limit discounted places to make sure we cover our costs. Please fill in below how much you can pay for the 10-day course. Invoices will be sent separately.

Do you require wraparound care?

This is just to give us a rough idea for staffing levels, we will send a separate booking form nearer the time

Possibly on selected days.

We will be taking photos at the course, please tick all the boxes which apply if you are happy for your child to be included. *

I give permission for my child's photograph to be used at the Holiday Course for display purposes.

I give permission for my child's photograph to be used within other printed publications.

I give permission for my child's photograph to be used on Margaret's Music Ltd's website.

I give permission for my child's photograph to be used on Margaret's Music Ltd's social media.

I give permission for video of my child to be used on Margaret's Music Ltd's website.

I give permission for video of my child to be used on Margaret's Music Ltd's social media pages.

I give permission for video of my child to be used for training or analysis purposes.

I confirm that I have read, or been made aware of, how these images or videos will be stored within the organisation .

Required

How did you hear about the course? *

Margaret's Music social media

Child's school

Lighthouse School of Speech, Drama and Communication social media

Poster/flyer in local community

Other:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms