Parental Consent Form 2017
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Please note young people cannot attend Love2Dance without a signed consent form.

All information will be kept confidential and not passed on to third parties.
 
Child's First Name: *

 
Child's Last Name: *

 
Child's Age *

 
Child's DOB *

 
Address: *

 
Postcode: *

 
Borough: *

 
Phone: *

 
If you would like to be added to the L2D whats-app group to be kept up to date with L2D, please specify a phone number we can include:

 
Are you a Lewisham Homes Resident? *

(Is your home a council property managed by Lewisham Homes)

 
How would you best describe your child (please answer yes or no for all that apply)

 
Does your child have a disability? *

     
 
Does your child have any additional requirements? I.e. learning or medical requirements?  *

     
 
If yes please provide further details

 
Doctors name, address and telephone number

 
Please chose which Love2Dance venue/class you would like to take part in: *


 
We will release any young people age 12+ without a parent/ guardian at the end of class/ events, however we will expect a parent or guardian to collect any young person age 11 and under.

 
My child is age 11 or under and I would like them to be released without a parent/ guardian

     
 
How did you find out about Love2Dance/Who referred you to Love2Dance? *

(School, Flyer, Website, Friends name, Neighbours name etc.)
 
Please choose the option that best describes your ethnicity? *


 
Consent (Please read carefully)

I consent to my son/daughter taking part in the programme and activities of Love2Dance including workshops, performances and show visits at Riverside/ TNG/ Honor Oak and The Albany. I consent to my son/ daughter travelling by any form of public transport or motor vehicle to and from any activities, performances or show visits that are located in other locations than TNG, Riverside or Honor Oak and understand that they will be accompanied by the organisers of Love2Dance. I confirm to the best of my knowledge that my son/daughter does not suffer from any medical condition other than those listed above. I give permission for my son/daughter to be filmed and/or photographed to document Love2dance activities and agree that photographs/ film footage of my son/daughter may be used by The Albany and Lewisham Homes for marketing purposes, together with any materials produced by and/or featuring Love2Dance participants. I understand that whilst the supervisory adults in charge of Love2Dance and will take all reasonable care of my son/daughter Lewisham Homes/ The Albany accept no responsibility for loss, damage or injury caused by or during attendance on any of the programmes activities, unless such loss, damage or injury results from the negligence of the supervisory adults or organisers.

 
It is parent's responsibility to communicate with the organisers of Love2Dance if their child will be unable to attend events, will be absent from rehearsals or will not be returning to the programme. You can do this by contacting us on 07984355826 or emailing love2dance@albany.org.uk

 
Emergency Contact Name: *

 
Relationship to young person: *

 
Emergency Contact Number (1) : *

 
Emergency Contact Number (2):

 
Today's Date *

 
Signed: *

 
If you have any questions, please contact us at love2dance@thealbany.org.uk

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