Enrolment Form

Step 1 Student Details

Procter Dance Academy would like to communicate with you, but in order to do so we require your consent. By completing this enrolment form you are authorising PDA to use your information as per section 5 of our PDA policies.

Student Name *

Student Date of Birth *

Student Home Address (including postcode) *

Telephone Number *

Email Address *

There are times when we may want to contact you. Please select one or more contact options:

Email Telephone Post

Step 2 Medical Infomation

Doctor's Name *

Doctor's Telephone Number *

Doctor's Address *

Please tell us if there is anything we should know about the student e.g. a disability, injury or health problem.

Please provide details of two contacts in the event of an emergency.

Medical Consent

I grant permission for the staff of Procter Dance Academy to seek medical advice and attention in the event of an emergency or when neither parent nor guardian can be contacted.

Step 3 Consent

Photographic Consent

It may be necessary for your child to be photographed and / or filmed during classes or performances, purely for promotional purposes and may be shared on social media.

The Academy will NOT allow pupils to be photographed or filmed by any person or persons who have not been checked by the Criminal Records Bureau.

I give consent to the photography and/or filming.

Covid 19 Parent Consent

PROCTER DANCE ACADEMY agrees to adhere to the UK government and the World Health Organisation (WHO) recommended ways to prevent the spread of infection.

PROCTER DANCE ACADEMY ensures the appropriate measures are in place; through displaying posters promoting hand washing and ensuring hand sanitiser/and or soap is available on the premises.

If your child (or anyone in your household) is unwell, even with a mild cough or fever, they should stay at home and will not be permitted onto the dance school premises.

The parent/legal guardian agrees that the PROCTER DANCE ACADEMY is not responsible for any spread of infection or contraction of Covid-19.

I confirm that I have read the above information and agree to conform to its stipulations/rules.

Terms & Conditions

I have read and accept the terms/conditions and policies.

I confirm that the information I have provided in the form is accurate.

Signature

Parent / Legal Guardian Name *

Form submission Date *

Parent / Legal Guardian Signature *

Please sign your name in the box below, then select the Use Signature button. You can use the Clear Signature button to restart the process.

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Confirmation

Section	Information Provided
Student Name:
Date of Birth:
Student Address:
Telephone Number:
Email Address:
Email Permission:
Telephone Permission:
Post Permission:
Doctor's Name:
Doctor's Number:
Doctor's Address:
Medical Notes:
1st Contact Name:
1st Contact Number:
1st Contact Relationship:
2nd Contact Name:
2nd Contact Number:
2nd Contact Relationship:
Medical Permission:
Photographic Permission:
Covid-19 Permission:
Terms & Conditions Permission:
Parent / Legal Guardian Name:
Form Submission Agreement:
Signature Date:
Signature:

Select the Submit button to submit your enrolment form, or Cancel to make alterations.