FUNKY BEATS REGISTRATION FORM

Funky Beats Registration Form

Classes run Monday and Thursday evenings:

Age Group(*)

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Preferred Start Term(*)

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Parent/Guardian Details

First Name(*)

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Second Name(*)

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Street Address(*)

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Street Address Line 2

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Town(*)

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County(*)

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Post Code(*)

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Phone Number

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Mobile Phone(*)

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Email(*)

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Alternative contact details.

(In case of emergency)

First Name(*)

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Second Name(*)

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Relationship to Student

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Phone(*)

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Alternative Phone

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Student Details

Students First Name(*)

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Students Last Name(*)

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Preferred Name

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Date Of Birth(*)

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Primary/Sibling(*)

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If Sibling, please add the name of the Primary Student

Sibling First Name

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Sibling Second Name

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Please give detailed information regarding any medical issues/disabilities that may affect the student's involvement.

Medical Details

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Click here to read our safeguarding policy

You have read our safeguarding policy(*)

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