NEW Joffrey Intensive Booking

SECTION 1 - PARENT / GUARDIAN

To be completed by the adult responsible for the payment and correspondence for anyone under 18.

First Name *

Surname *

Home Telephone *

Mobile Telephone *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

SECTION 2 - DANCER(S)

Number Of Dancers

Dancer 1 - Details

Full Name *

Date of Birth *

Gender *

Dance School currently attended

Dancer 1 - Medical Conditions

Does your child have any existing medical conditions requiring treatment or medication? If yes, please provide details below.

Does your child have any allergies? (e.g. food, medication, plasters etc.)

Dancer 1 - Emergency Contact

Full Name *

Home Telephone *

Mobile Telephone *

Relationship to Child *

Dancer 2 - Details

Full Name *

Date of Birth *

Gender *

Dance School currently attended

Dancer 2 - Medical Conditions

Does your child have any existing medical conditions requiring treatment or medication? If yes, please provide details below.

Does your child have any allergies? (e.g. food, medication, plasters etc.)

Dancer 2 - Emergency Contact

Full Name *

Home Telephone *

Mobile Telephone *

Relationship to Child *

Dancer 3 - Details

Full Name *

Date of Birth *

Gender *

Dance School currently attended

Dancer 3 - Medical Conditions

Does your child have any existing medical conditions requiring treatment or medication? If yes, please provide details below.

Does your child have any allergies? (e.g. food, medication, plasters etc.)

Dancer 3 - Emergency Contact

Full Name *

Home Telephone *

Mobile Telephone *

Relationship to Child *

Dancer 4 - Details

Full Name *

Date of Birth *

Gender *

Dance School currently attended

Dancer 4 - Medical Conditions

Does your child have any existing medical conditions requiring treatment or medication? If yes, please provide details below.

Does your child have any allergies? (e.g. food, medication, plasters etc.)

Dancer 4 - Emergency Contact

Full Name *

Home Telephone *

Mobile Telephone *

Relationship to Child *

Dancer 5 - Details

Full Name (copy) *

Date of Birth (copy) *

Gender (copy) *

Dance School currently attended (copy)

Dancer 5 - Medical Conditions

Does your child have any existing medical conditions requiring treatment or medication? If yes, please provide details below.

Does your child have any allergies? (e.g. food, medication, plasters etc.)

Dancer 5 - Emergency Contact

Discount Telephone Child

Full Name (copy) *

Home Telephone (copy) *

Mobile Telephone (copy) *

Relationship to Child (copy) *

SECTION 3 - HOW DID YOU HEAR ABOUT THE JOFFREY X CYD? INTENSIVE?

How did you hear about the Joffrey x CYD? Intensive?

Facebook
Instagram
Twitter
Other

Other - (please give details) *

SECTION 4- ADD DISCOUNT CODE

Add Discount Code

SECTION 5 - CONFIRMATION & CONSENT

Video recordings and photographs will be taken during the Intensives and used for publicity and promotional purposes. The images and recordings will become property of Can You Dance? and will remain as such until the time that they are deleted. If you do not wish your child to be included in any of the recordings or photographs please make yourself known to a CYD? team member at the Intensive.

Terms and Conditions *

Do you agree to our booking and event Terms and Conditions?

Contacting You

Do you consent to both CYD? & Joffrey Ballet School contacting you via email about events, products and services?

MAKE PAYMENT

Stripe Credit Card *

Price To Pay

£0.00

Joffrey x CYD? Intensive Booking

Price - £285

SECTION 1 - PARENT / GUARDIAN

SECTION 2 - DANCER(S)

Dancer 1 - Details

Dancer 1 - Medical Conditions

Dancer 1 - Emergency Contact

Dancer 2 - Details

Dancer 2 - Medical Conditions

Dancer 2 - Emergency Contact

Dancer 3 - Details

Dancer 3 - Medical Conditions

Dancer 3 - Emergency Contact

Dancer 4 - Details

Dancer 4 - Medical Conditions

Dancer 4 - Emergency Contact

Dancer 5 - Details

Dancer 5 - Medical Conditions

Dancer 5 - Emergency Contact

SECTION 3 - HOW DID YOU HEAR ABOUT THE JOFFREY X CYD? INTENSIVE?

SECTION 4- ADD DISCOUNT CODE

SECTION 5 - CONFIRMATION & CONSENT

MAKE PAYMENT