Masterclass with Gareth Haw

First name

Last name

Birthday

Day

Month

Year

Address

Email

Phone

Emergency contact

Current Ballet School if applicable

Current school year if applicable

Have you been under the care of a doctor or physiotherapist in the last 6 months? If so, please state why:

Are there any specific allergies or medical needs the school needs to be aware of?

I consent to my child's image/video being taken and used online or in print for the purposes of promotion for future events at West London School of Dance and The Du Boisson Dance Foundation

Yes

No

Do you give permission for the student to travel home alone at the end of the day? If applicable

Yes

No

N/A

Course Group - ballet training is essential

Year 8, 9, 10, 11

Year 12 to pro