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Little Voices Brentford, Ealing & Wembley Virtual Consent Recording Form
Virtual Lesson Application Form
Parent's Name
*
First
Last
This form must be filled in by the parent / legal guardian of the named child applying to take part of the Virtual Lessons.
Child's Name
*
First
Last
Child's Date of Birth
*
Day
1
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Year
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Child's Age*
Please enter a number from
4
to
18
.
Child's Gender
*
Male
Female
Address
*
Street Address
Address Line 2
City
County
Post Code
Contact Telephone Number
*
By completing this field you are consenting to Little Voices contacting you by telephone to arrange Virtual Lessons for your child.
Contact Mobile Number
*
Email Address
*
Experience to date (eg.any relevant Examinations taken or performances etc.)
*
Yes
No
Please give details.
*
Are there any medical conditions or medication that your child is taking that we need to be aware of?*
*
Yes
No
Please give details.
Which school does your child attend?
How did you find out about Little Voices?
A friend or relative
Flyer
Social media
A newspaper/website ad
Event
A search engine (eg Google)
Dramaclasses.biz
Netmums
Another school
Other
Emergency Contact Name
*
Please give a different emergency contact to you.
Emergency Contact Number
*
Please give a different emergency contact number than your own.
When is the best time for us to contact you?
Is there anything else you would like to tell us?
I give consent for Little Voices to record my child's lesson for safeguarding purposes.
Yes. I give consent.
No. I do not give consent.
Important Information
I consent to Little Voices using my personal data and sensitive data relating to my child for the purposes of organising Virtual Lessons and in accordance with the Little Voices terms and conditions and privacy policy.
I confirm that I am the parent / legal guardian for the child named above.
I consent to Little Voices contacting me with news by telephone, email, post and text, newsletters about the lessons, workshops, theatre weeks and events that it runs. I understand that my personal information is not shared outside of Little Voices for 3rd party marketing purposes. Personal data is only used in relation to Little Voices. I understand that I can withdraw my consent at any time by notifying Little Voices.
By submitting this form I give permission for the above named child to attend Little Voices for Virtual Lessons and on the date confirmed once the application is submitted, approved and processed. I confirm that all the information given is accurate. Little Voices cannot accept responsibility for any inaccurate information provided. I confirm that I will be around whilst by child is having their virtual lesson. I understand that submission of an Application Form and subsequent attendance at a Free Trial lesson is not a guarantee that Little Voices has a group available for my child to attend weekly either virtually or physically. I understand that I may be required to give more information to support my application. *more information and proof of examinations may be requested. **more information may be requested.
We are agreeing to take the lessons at home at our own risk.
Comments
This field is for validation purposes and should be left unchanged.
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Contact
Principal:
Jemma Bird
Telephone:
07877620340
Email Address:
ealing@littlevoices.org.uk
Venue
Ealing Abbey Parish Centre and Abbey Hall, 2 Marchwood Crescent, London W5 2DZ
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