drama classes Registration Form PARENT/GUARDIAN INFORMATION Parent/ Guardian's Full Name * First Name Last Name Phone Number * Email * Full Address * Child One Child One's Full Name * First Name Last Name Date of Birth * Gender * Female Male Other Which day would you like to enrol Child 1 in? Kindy Class Prep-Grade Two | Monday Early Primary Grades One -Three | Tuesday Early Primary Grade Four-Six | Tuesday Grade Four-Six | Wednesday Grade Three-Six | Thursday Prep-Grade Three | Friday Teens | Tuesday Teens | Thursday Primary Acting Bootcamp Full Program Primary Acting Program Day One (Monday) Primary Acting Program Day Two (Tuesday) Primary Acting Program Day Three (Wednesday) Primary Acting Program Day Four (Thursday) Child Two Leave blank if N/A Child Two's Full Name First Name Last Name Date of Birth Gender Female Male Other Which day would you like to enrol Child 2 in? KindyClass Prep-Grade Two - Monday Grades One-Three - Tuesday Early Primary Grades Four-Six – Tuesday Advanced Primary Grade Four - Grade Six – Wednesday Advanced Primary Grade Three-Grade Six– Thursday Advanced Primary Teens - Tuesday Teens - Thursday Primary Acting Bootcamp FULL PROGRAM Primary Acting Bootcamp Day One (Monday) Primary Acting Bootcamp Day Two (Tuesday) Primary Acting Bootcamp Day Three (Wednesday) Primary Acting Bootcamp Day Four (Thursday) Child Three Leave blank if N/A Child Three's Full Name First Name Last Name Date of Birth Gender Female Male Other Which day would you like to enrol Child 3 in? Prep- Grade Two | Monday Early Primary Grade One - Grade Three | Tuesday Early Primary Grade Four - Grade Six | Tuesday Advanced Primary Grade Four - Grade Six | Wednesday Advanced Primary Grade Three - Grade Six | Thursday Advanced Primary Teens | Tuesday Evening Teens | Thursday Evening Emergency Contacts Emergency Contact 1 * First Name Last Name Emergency Contact 1 - Phone Number * Emergency Contact 2 * First Name Last Name Emergency Contact 2 - Phone Number * Medical Information Do any participants have a disability of movement limitation? * Yes No Do any participants have a history of asthma? * Yes No Do any participants have a history of seizures? * Yes No Do any participants have any allergies (and/or is affected by anaphylaxis) * Yes No Do any participants have any emotional or behavioural problems? * Yes No Do any participants have any other special requirements? i.e. Cultural/Religious. * Yes No If you answered yes to any of the questions above, please let us know the details below. Can a band-aid be applied to the participants? * Yes No Do you give permission for photographs or recordings of the participants to be taken?* * Room to Play Drama Studio promotes the appropriate use of photographic and video images of children attending our programs. In the interest of children’s safety and well-being, Room to Play will seek permission before photographing or recording images of children, and using their images for promotional purposes. These images / recordings may be used for promotional purposes which may include, but is not limited to: Room to Play approved social media sites (e.g. Facebook, Instagram), Room to Play website. Yes No Is there anything else you want to let us know? How did you hear about Room To Play? * Thank you! We look forward to having you in our class and will be in touch with the next steps including an invoice shortly.
