£10 TRIALS

CELEBRATING 20 YEARS OF DANCE, PASSION AND PERFORMANCE

    Emergency Contact

    Child Name

    Date of Birth

    Parent/Guardian Name

    Email Address

    Mobile Number

    Other Contact Number

    Additional Emergency Contact Name

    Emergency Contact Number

    Address

    Medical

    Does your child have any existing medical conditions, allergies, disabilities, or additional needs?

    YesNo

    Is your child receiving medical treatment?

    YesNo

    In the unlikely event of an emergency, we will always try to contact you first. However, if you cannot be reached, please confirm your permission to take your son/daughter to hospital or to a doctor for treatment:

    YesNo

    Consent

    I give consent for my child to be filmed and photographed by an external media service for use in the show recording and for promotion & advertising purpose

    YesNo

    For any secondary school aged students from Y7 – Y13, do you give permission for your child to go off site between performances on Saturday 2nd May?

    YesNo

    I am happy for my child’s name to appear in the show recording and programme

    YesNo

    Please note, for performers of compulsory school age, all medicines must be handed to the Head Chaperone. Medicines cannot be administered without the express permission and guidance of the parent/guardian.

    Parent Declaration


    I give my consent for my child to participate in “ENCORE” on; 01/05/26 & 02/05/26 at Royal Spa Centre, Leamington. I understand that during the show and rehearsal dates that my child will be left in the care of Jaykays Dance Company and their team of chaperones.

    I understand that Jaykays Dance Company will only be responsible for my child during the stated dates and times as outlined on the rehearsal and performance schedule

    Parent Name

    Date

    Signature


    I confirm all details are accurate.