LHR MT REGISTRATION FORM

BOUNDLESS ARTS MT CLUBS REGISTRATION FORM

To book into a Boundless Arts School Club/Community Class please
complete the Registration Form below.

Please complete all sections of the form below otherwise your form
will be invalid.

Please note, completing this form does not confirm your place. Your place will be confirmed by email
along with payment details upon a successful application.
If you are not successful this time then your details will be added to the class waiting list, and we hope
to be in touch as soon as possible to offer a confirmed place. You must re-apply for every new term by email.

1. PARTICIPANT'S NAME & DATE OF BIRTH:

2. SCHOOL NAME & SCHOOL CLASS, or move to next entry

3. COMMUNITY CLASS NAME:

4. EMERGENCY CONTACT NAME & NUMBER FOR PARTICIPANT:

5. CONTACT EMAIL FOR CONFIRMATION:

6. CLASSES FOR CHILDREN: Please list who your child will be collected by throughout the term.

7. PLEASE LIST ANY MEDICAL NOTES, ALLERGIES AND/OR DIAGNOSED BEHAVOURIAL NEEDS:

I GIVE PERMISSION FOR IMAGES AND/OR VIDEOS OF THE PARTICIPANT TO BE USED BY BOUNDLESS ARTS FOR PUBLICITY:

I confirm that the information given in this form is true, and that I have read and understood the Boundless Arts Terms & Conditions.View Terms and Conditions

DATE:

FULL NAME OF PARENT/CARER: