Confi street dance school years 1 - 6 and its FREE

Join this 10 week course where the children will be learning 2 dances, learning about good morals and values and then at the end of the 10 weeks they will perform a short 30min dance show for you all, we have enough space for 18 young people! You will need to either get a form from the church office or you can copy and paste the form below then fill out the form and send it back to the church so your child can have a place. ConfiDANCE Children and Youth Consent Form. This personal information shall be kept securely and only used for ConfiDANCE related activities/ medical emergencies. Name of group you are signing up to_________St Mary's and St James_________________________________________________ Name of Child_____________________________________________________ Date of Birth_______________ Address__________________________________________________________ Postcode__________________ Home phone number________________________________ Mobile__________________________________ Email___________________________________________________ (Newsletters regularly sent electronically) Name of School_____________________________________________________________________________ Emergency contact name and number___________________________________________________________ Name of Doctor’s Surgery___________________________________________ Number___________________ If the need arises, can your child be given pain relief by club leaders? YES/ NO. Name of pain relief normally taken______________________________________________________________ Please list any allergies (ie foods, medicines, animals etc): ____________________________________________________________________________________________________________________________________________________________________________________ Any significant medical/ personal information? (ie special diet/ medical conditions): ____________________________________________________________________________________________________________________________________________________________________________________ Special medical treatment required (Please provide written medical instructions): ____________________________________________________________________________________________________________________________________________________________________________________ Do you give consent for your personal details to be used to contact you in relation to ConfiDANCE activities? (eg: session information/ change of dates etc) YES / NO Do you Give permission for your child to attend activities/ events/ performances etc with ConfiDANCE Clubs that are held both on and off the premises? (you will always be notified with full details of these) YES / NO. If it becomes necessary for your child to receive emergency dental or medical treatment and you cannot be contacted by telephone or any other means to authorise this, do you consent to any necessary treatment and authorise the group leader to sign any documents required by the hospital authorities? YES / NO. - Please tick to indicate that you have signed the separate ConfiDANCE Media Consent form that has full details of our media and information sharing policy. I acknowledge the need for my child to behave responsibly whilst at any ConfiDANCE Event. I agree to confirm these details on an annual basis and notify the leaders if any personal details change throughout the year. Signature____________________(Parent/Carer) Printed____________________ Date___________