Child's Name *

Date of birth *

Year group *

School they are attending *

Parent / guardian name *

Address *

Phone number *

Your Email *

Event your child is taking part in (for example one-day workshop, after-school club) *

The safety of your child is of utmost importance to us at JumpStart Dance. Please complete the information below so we can ensure we can provide the best care possible for them during their dance event.

Does your child have any current illnesses or injuries we need to know about? Please include all information about any medications they may be on *

Does you child have any medical conditions we need to know about? Please include all information about any medications they may be on *

Emergency contact name *

Emergency contact number *

I consent to photos and/or video footage being taken of my child during JumpStart Dance events. These may be used on the company website, publicity, educational resources and social media. No names will be used alongside images. Please check the box if you agree

I confirm that the above information is correct. I will contact JumpStart Dance at the earliest opportunity if any of the details change, especially the emergency contact and health information. I confirm *

Yes, I’m happy to give you personal data because I know you’ll keep it safe and secure.

Your privacy matters to us. We promise to keep your information safe and we’ll only get in touch with you according to your preferences.
You can read more about how we store and use data in our privacy notice.

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