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All-In Booking form
Inclusive youth dance taster workshops
12-19 years old
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Email
*
Your email
Workshops organised by Shropshire Inclusive Dance
Workshop date
*
Wednesday 17th April 1:30-3:30pm
Tuesday 13th August 1:30-3:30pm
Monday 28th October 1:30-3:30pm
Required
Name of participant
*
Your answer
Date of birth and age of participant
*
Your answer
Address
Your answer
Postcode
Your answer
Contact phone number
*
Your answer
Emergency contact name and number
*
Your answer
Does your child/dependent have any medical conditions that we should know of eg. Diabetes, epilepsy, hearing impairment etc?
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Your answer
Does your child/dependent have any specific access needs that we need to be aware of?
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Yes
No
If yes, tell us more
Your answer
Has your child/dependent had any previous participation in dance workshops? If so please give details
Your answer
What would your child/dependent like to get out of participating in the dance workshop?
Your answer
I give permission for photographs/video footage to be used in future publication material by Shropshire Inclusive Dance
*
Yes
No
I give permission for photographs/video footage to be used online on Shropshire Inclusive Dance website and social media platforms
*
Yes
No
I give permission for Shropshire Inclusive Dance to add my basic details to our database and mailing list
*
Yes
No
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