Children and Teens Trial Form

We are looking forward to seeing you at your first session. Before you attend, please take a few minutes to complete the following information. Thank you.

CHILD DETAILS:

* Indicates required field

Name *

First

Last

Date of Birth *

PARENT/GUARDIAN CONTACT DETAILS:

Name *

First

Last

Address *

Post Code *

Email *

Mobile Telephone Number *

Home Telephone Number *

Relationship to Child *

MEDICAL INFORMATION:

If there are any medical conditions we need to be aware of, please fill in the information below. If this is not applicable, leave this space blank.

Conditions *

DISCLAIMER

If I feel uncomfortable with any of the class exercises, games or modules; I will inform the class teacher immediately. I understand that this is NOT a formal offer to attend IPM Acting Academy, a decision will be ultimately made at the end of the trial session. I agree to take full responsibility for myself and for everything that happens to me in relation to the acting classes.

Please tick this box if you would NOT like your photograph to appear in any of our publicity material such as brochures, advertisements, our website and/or workshop content. Ticking this box may exclude you from some of our future projects. *

I do NOT give consent for my photograph to be used.

The personal data included in this form will be 'Processed' (as such terms are defined in the Data Protection Act 1998) by IPM, for the purpose of administration. IPM will not disclose this information to third parties for marketing purposes but may itself provide you with company marketing information.

NAME *

I agree to the disclaimer and confirm that the above information is correct to the best of my knowledge. *

Yes

Submit

CHILDREN AND TEENS Trial SESSION

CHILD DETAILS:

PARENT/GUARDIAN CONTACT DETAILS:

MEDICAL INFORMATION:

DISCLAIMER

Contact Us

CHILDREN AND TEENS Trial SESSION

​CHILD DETAILS:

PARENT/GUARDIAN CONTACT DETAILS:

MEDICAL INFORMATION:

DISCLAIMER

Contact Us

CHILD DETAILS: