Name of Child Attending *

First Name

Last Name

Emergency Contact *

First Name

Last Name

Emergergency Contact Number *

(###)

###

####

Does the person attending have any medical conditions that we should be aware of? *

Yes

No

Consent *

I acknowledge the complete details regarding The Ballet House ‘workshop’ in which my child is participating and herby consent my child to participate in the activities provided by The Ballet House for the session, which is being held at Royal Ballet & Opera, Covent Garden, London, WC2E 9DD. I am doing so at my own risk and will not hold The Ballet House or Royal Ballet & Opera liable in the unlikely event of any incident or accident. I permit medical attention to be sought in case of emergency I understand that The Ballet House cannot take responsibility if my child does not adhere to the Royal Ballet & Opera rules.

I give consent for my child to participate