Registration form

Emergency Contact:
If we are unable to reach you for any reason whom else should we contact?
Name		Name
Tel		Tel

Named person collecting child
	Relationship to child
	Relationship to child

Please Note:
Children will only be dismissed with persons named on this Registration Form unless prior notice has been given. Any student travelling to and from by themselves need to provide a letter of consent.

Does your child have any Special Requirements?		Yes No
Diet		Yes No
Disabilities		Yes No
Allergies		Yes No
Learning Difficulties		Yes No
Other
If YES, please give details
I also consent to any emergency medical treatment necessary during the running of the Performing Arts School. I authorize Platinum Performing Arts staff to sign any written form of consent required by the hospital authorities if the delay in getting my signature is considered by the doctor to endanger my child’s health and safety.
Yes No

I do do not give consent for photos/videos of to be used on Platinum Performing Arts website and/or for promotional flyers.

Name

Please indicate size required:

T Shirt:

5/6 years 7/8 years 9/11 years 12/13 years 14/15 years
Adult Small Medium Large

Tracksuit Bottoms:

5/6 years 7/8 years 9/11 years 12/13 years 14/15 years

Adult Small Medium Large X-Large

Please note:
Hooded tops can be purchased separately.