Summer School Membership Form

Child/Children Full Name(s): (required)



Parent/Guardians Full Name: (required)

Child/Children DOB:(required)



Does your Child/Children have any of the following? You can select multiple options.
AsthmaAny Allergies including FoodAny Skin ConditionsHearing ImpairmentVisual ImpairmentAny Learning DisabilityAny Physical DisabilityAny Medical Conditions?Taking Any Regular Medication(s)?Been to see or had a referral to a hospital consultant in the last 6 months?

If Yes to any of the above please give details here, if No, please state No:

*As defined within section 3 of the Children Act 1989, ‘parental responsibility’ means all of the rights, duties, powers, responsibilities and authority which by law a parent of a child has in relation to the child and his property.

I confirm that I have parental responsibility for these Child/Children. *Please use your mouse to sign in the box or use your finger on a mobile device.

How do you wish to pay?: (required)

Will your Child/Children require breafast?: (required)

Will your Child/Children require Late Pick Up?: (required)

Please click to give permission to Bishops Stortford Academy of Performing Arts permission to take photographs and/or video your child.
YesNo

I grant Bishops Stortford Academy of Performing Arts full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the group’s aims. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, press releases and funding applications.
YesNo

Print Name (required)

Print Todays Date (required)

Parent / Guardian Home Address (required)

Parent / Guardian Email (required)

Parent / Guardian Telephone (required)

Doctors Name and Address (required)

Doctors Email

Doctors Telephone (required)

How did you hear about us? (required)

Additional Info

Terms and Conditions

We want you to know how our service works and why and how we handle your data. Please state that you have read and agreed to these terms and conditions.

I Agree to the Membership Terms and Conditions Membership Terms and Conditions

Contact Permission
Occasionally we would like to send you newsletters and offers and the latest info from Bishops Stortford Academy of Performing Arts by Email, post, SMS and other electronic means. We take your privacy very seriously and will only use your personal information to administer your account and to provide the services you have requested from us. If you consent to us contacting you for this purpose please tick to say how you would like us to contact you.
PostEmailTelephoneSMS

Are You Human?
captcha

By using this form you agree with the storage and handling of your data by this website.

Spread the love
//]]>