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Student Name

Parent Name

Student D.O.B.

Day

Month

Year

Phone

Street Address

City

Post Code

Please upload a candidate headshot for identification purposes only

How did you hear about us?

Please let us know about your ballet background.

Name of Dance School

Do you have your dance teachers permission to audition?

Yes

We kindly request your permission for Yorkshire Classical Associates to photograph your child, for promotional purposes only.

Yes, I give consent

No, I do not give consent

Does your child have any Allergies/Medical Information we need to know about?

Yes

If yes, please provide further detials below

Further medical information

Emergency Contact Name

Phone

Please list any further comments/questions that you would like to support your application.

Signature (Parent/Guardian)

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