Member

Price:

£10

We need the following information about your child in order to provide the best possible learning experience and to make sure your child is safe when at Theatre Peckham. Please note that your child's place on their course is not confirmed until after this form is returned to us. ONE FORM PER CHILD/YOUNG PERSON: We need the following information about your child in order to provide the best possible learning experience and to make sure your child is safe when at Theatre Peckham. Please note that your child's place on their course is not confirmed until after this form is returned to us. ONE FORM PER CHILD/YOUNG PERSON is not valid

Childs Full Name:* Childs Full Name is Required

Childs Date of Birth:* Childs Date of Birth is Required

Parent/Carer name:* Parent/Carer name is Required

Parent/Carer phone number:* Parent/Carer phone number is Required

Address:* Address is Required

Postcode:* Postcode is Required

Name of childs school or alternative: Name of childs school or alternative is not valid

Emergency contact name (this must be different to the parent/carer named above):* Emergency contact name (this must be different to the parent/carer named above) is Required

Emergency contact phone number (this must be different to the parent/carer phone number above):* Emergency contact phone number (this must be different to the parent/carer phone number above) is Required

Can the child go home alone?:* Can the child go home alone? is Required

Yes No

Does your child have any physical, health or educational needs which we need to know about in order to support them?:* Does your child have any physical, health or educational needs which we need to know about in order to support them? is Required

Yes No

If you answered yes to the above please provide details about your child's needs here:: If you answered yes to the above please provide details about your child's needs here: is not valid

What is your child's ethnic group?: What is your child's ethnic group? is not valid

Asian/Asian British: Asian/Asian British is not valid

Indian Pakistani Bangladeshi Chinese Any other Asian background

Black/Black British: Black/Black British is not valid

African Caribbean Any other Black background

Dual Heritage: Dual Heritage is not valid

White and Black Caribbean White and Black African White and Asian Any other Mixed Background

Other: Other is not valid

Arab Any other ethnic group Prefer not to say

White: White is not valid

British Irish Gypsy or Irish Traveller Any other White background

Name of TP Academy Class(es)/Company:* Name of TP Academy Class(es)/Company is Required

Are you happy for TP to use photos of your child(ren) to appear in Theatre Peckham's marketing material?:* Are you happy for TP to use photos of your child(ren) to appear in Theatre Peckham's marketing material? is Required

Yes No

How did you hear about us?:* How did you hear about us? is Required

I have read, understood and agree to the Terms and Conditions of the TP Academy detailed on the website*

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Coupon Code:

Invalid Coupon

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