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Autin Dance Theatre's all-male Youth Dance Company - Registration Form
Thank you for your interest in coming along to our Weekly All Male Youth Sessions, starting on 9th April 2024.

Tuesdays, 5-7pm
Mac Birmingham


If you have any questions then please email kirsten@autindt.co.uk.
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Participant Name: *
Main Contact Number: *
Main Contact Email Address: *
Age: *
Emergency Contact Name (and relation to participant) *
Emergency Contact Number *
Medical Conditions: *
Accessibility Needs: *
Media Consent Terms and Conditions:
I hereby grant Autin Dance Theatre and any assignees or licensees the absolute right to use the images resulting from the photography/video filming shoot, and any reproductions or adaptations of the images for any purposes in relation to AutinDT’s work including, without limitation, the right to use them in any publicity and learning materials such as broadcasting, newspapers, magazines, leaflets, brochures and posters, direct mail, newsletters and e-news, and publications for public events and the Internet such as learning resources, case studies, films, blogs and social media.

I understand that the images will not be identified with the name of the individual unless this has been specifically agreed for the individuals name to be used, and that text may suggest that the individual has taken part in a project with AutinDT in order to promote AutinDT’s work.

I understand that AutinDT will keep all the images and use them for such period as it considers appropriate, and will move them into its image archive for posterity.

(OVER 18 ONLY) I give consent to be filmed and photographed during the all Male Youth Dance Sessions. I understand that the images collected during the filming and creation will be used for monitoring and promotional purposes as explained above.
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(UNDER 18 ONLY) As a parent/guardian, I give consent for my child to be filmed and photographed during the all Male Youth Dance  Sessions. I understand that the images collected during the filming and creation will be used for monitoring and promotional purposes as explained above.
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Name of Under 18 Participant:
Thank you for filling out our registration form!
If you have any questions or queries, please do not hesitate to get in contact with us.

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