October Holiday Drama Workshops 2019
Postal and Studio Address: 17 Badgery Avenue, Homebush, NSW, 2140
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Student Name: *
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Home Address: *
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Date of Birth: *
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School Attended: *
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School Grade: *
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Enrolment: *
Fees: *
PARENT / GUARDIAN INFORMATION
Mother/Father or Guardian's Full Name:
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Contact Email:
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In case of Emergency:
Name:
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Does your child have any medical condition / impairment / disability you feel we should be informed about:
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Does your child suffer from Asthma? *
Does your child have any food allergies or intolerances? *
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Does your child have any other allergies? *
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IN CASE OF EMERGENCY, I give The Hennessy Speech and Drama Studio permission to call an ambulance and understand I must meet any costs incurred. I am aware that Kidz on Stage will make every effort to contact me or an emergency contact as listed on this form. *
I give permission for photographs of my child or video footage, taken in class, to be used in promotions, advertisements and information packages (eg. On our website, for newspaper advertisements and on promotional fliers). *
PAYMENT OPTIONS accepted: *
Fee amount Enclosed: *
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