Registration form:

1. Student Details

Student Name*

Student Surname*

Preferred Name (if any)

Gender*

Student Date of Birth*

School Attended

Previous Experience:*

Previous Experience*

Medical Information:

Any information we should know?

Anything else we need to know?

Permission for us to seek medical advice/treatment in an emergency.*

Emergency medical permission *

2. Contact Details

Registering Parent/Guardian

Parent Name*

Parent Surname*

Parent Email*

Parent Phone*

Address*

City

Postcode

Does Student normally live at this address?

Yes No

3. Emergency Contact Details

Additional Emergency Contact (not yourself)

Name of additional emergency contact

Relationship to Student

4. Additional Permissions

Permission to leave unaccompanied

Yes No

If applicable: Add any additional people authorised to collect your child.

Full Name - Additional Person 1

Full Name - Additional Person 2

How did you hear about us? (optional)

How did you hear about us?

Declaration

By submitting this form I give permission for the child named on this form to participate in activities at National Performing Academy Ltd (NPA). I understand publicity photographs and videos may be taken and give permissior for this.

Please refer to National Performing Academy’s Terms & Conditions and Privacy policy for the course for more detailed information. By signing below, you sign that you have read and agree to NPA’sTerms and Conditions and Privacy Policy.

I agree to the above and have read the relevant policies.

Newsletter

Keep me up to date on news from the National Performing Academy.

I confirm I am the child's legal parent/guardian.