How many children to you wish to enrol?*

1
2
3
4

Which age groups will your children be enrolled in?*

5-6
7-9
9-12
13-16

Which day?*

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Holiday Workshops

Parent/Guardian Information

Name*

First Name Last Name

Email*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Child 1 Details

Name*

First Name Last Name

Date of Birth

Gender

Male
Female
Other

Medical Information

Emergency Contact (1)

Name*

First Last

Phone*

Emergency Contact (2)

Name

First Last

Phone

Can a band-aid be applied to the participant?

Yes
No

Does the participant have a disability of movement limitation?

Yes
No

Please specify

Does the participant have a history of asthma?

Yes
No

Please provide specifics including any triggers and management strategies

Does the participant have a history of seizures?

Yes
No

Please specify what type of seizures are experienced and provide a management plan

Does the participant have any allergies (and/or is affected by anaphylaxis)

Yes
No

Please specify

Does the participant have any emotional or behavioural problems?

Yes
No

Please specify

Does the participant have any other special requirements? i.e. Cultural/Religious.

Yes
No

Please specify

Child 2 Details

Name

First Name Last Name

Date of Birth

Gender

Male
Female
Other

Medical Information

Emergency Contact (1)

Name

First Last

Phone

Emergency Contact (2)

Name

First Last

Phone

Can a band-aid be applied to the participant?

Yes
No

Does the participant have a disability of movement limitation?

Yes
No

Please specify

Does the participant have a history of asthma?

Yes
No

Please provide specifics including any triggers and management strategies

Does the participant have a history of seizures?

Yes
No

Please specify what type of seizures are experienced and provide a management plan

Does the participant have any allergies (and/or is affected by anaphylaxis)

Yes
No

Please specify

Does the participant have any emotional or behavioural problems?

Yes
No

Please specify

Does the participant have any other special requirements? i.e. Cultural/Religious.

Yes
No

Please specify

Child 3 Details

Name

First Name Last Name

Date of Birth

Gender

Male
Female
Other

Medical Information

Emergency Contact (1)

Name

First Last

Phone

Emergency Contact (2)

Name

First Last

Phone

Can a band-aid be applied to the participant?

Yes
No

Does the participant have a disability of movement limitation?

Yes
No

Please specify

Does the participant have a history of asthma?

Yes
No

Please provide specifics including any triggers and management strategies

Does the participant have a history of seizures?

Yes
No

Please specify what type of seizures are experienced and provide a management plan

Does the participant have any allergies (and/or is affected by anaphylaxis)

Yes
No

Please specify

Does the participant have any emotional or behavioural problems?

Yes
No

Please specify

Does the participant have any other special requirements? i.e. Cultural/Religious.

Yes
No

Please specify

Child 4 Details

Name

First Name Last Name

Date of Birth

Gender

Male
Female
Other

Medical Information

Emergency Contact (1)

Name

First Last

Phone

Emergency Contact (2)

Name

First Last

Phone

Can a band-aid be applied to the participant?

Yes
No

Please specify

Does the participant have a disability of movement limitation?

Yes
No

Please specify

Does the participant have a history of asthma?

Yes
No

Please provide specifics including any triggers and management strategies

Does the participant have a history of seizures?

Yes
No

Please specify what type of seizures are experienced and provide a management plan

Does the participant have any emotional or behavioural problems?

Yes
No

Please specify

Does the participant have any other special requirements? i.e. Cultural/Religious.

Yes
No

Please specify

Taking and Using Images of Children Permission

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.

Do you give permission for photographs or recordings of the participant to be taken?*

Yes
No

Payment

Fee is $315 for the term. We run a 9 week term. ($35 per class)
Holiday Workshops are $350 for a 4 day workshop.

By clicking Submit, you will be taken to Paypal to finalise payment.

Product Name

Price: $ 0.00

Product Name

Price: $ 0.00

Room to Play Drama Studio

Parent/Guardian Information

Child 1 Details

Medical Information

Emergency Contact (1)

Emergency Contact (2)

Child 2 Details

Medical Information

Emergency Contact (1)

Emergency Contact (2)

Child 3 Details

Medical Information

Emergency Contact (1)

Emergency Contact (2)

Child 4 Details

Medical Information

Emergency Contact (1)

Emergency Contact (2)

Taking and Using Images of Children Permission

Payment

Contact Info