Step 1 of 4 25% What Class are you registering for?(Required) Saturday Art Class Youth Theatre Child / Young Person InformationFirst Name Surname Date of Birth DD slash MM slash YYYY GenderMaleFemaleNon-binaryHome Address Street Address City Post Code Parent / Guardian InformationFirst Name Surname Home No.MobileEmail Are the emergency contact details the same as the Parent / Guardian Information? Yes First Name Surname Relationship to Child / Young Person Contact Number Medical QuestionnaireDisabilityFor the purposes of the Equality Act 2010 a person has a disability if they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day to day activities. Does your child have a disability, long standing ilness or infirmity? No Disability Autism Spectrum Disorder / Aspergers Syndrome Dyslexia / Dyspraxia / ADHD Mental health difficulties Blind / partially sighted Unseen Disability e.g. diabetes, epilepsy Deaf / hearing impairment Multiple Disabilities Wheelchair User / Mobility difficulties Not listed above Disability not listed above (if so please state below) More information about other disability. Important InformationIn case of an emergency, is there anything in your child's medical history we need to know about? Yes No Please give details of any information we should in case of an emergency.Does your child have a medical condition that we should know about? Yes No Please give details about symptoms we should look out for and actions that should be taken in the event of a medical issue:Is your child taking medicine or receiving medical treatment? Yes No If so, please give us details below:Does your child have any mental health conditions, additional learning needs or behavioural issues that we should be aware of? Yes No Please give details about how we can help your child participate:Is your child responsible for caring for anyone? Yes No If yes, please tell us who: Consent(Required)I am willing to allow my child, as named above, to attend classes at Arts Centre Washington. As far as I am aware my child has not been in contact with any infectious disease for the last three weeks and is in good health. In the event of my child being taken ill or injured during a class or course at Arts Centre Washington to the extent that a surgical operation or serum injection becomes neccessary, I authorise the leaders present to sign on my behalf any forms of consent which may be required by the medical authorities, provided that the delay required to obtain my own signature might be considered likely, in the opinion of the doctor or surgeon concerned, to endanger the health or safety of my child. I consent. Promotional Materials & Use in the Media Consent While taking part in classes and courses at the Arts Centre your child may be photographed or recorded on video for evaluation purposes. Arts Centre Washington, Sunderland Culture or Sunderland City Council may choose to use this material for publicity purposes and these images may appear in local or national newspapers, or on televised news programmes. To comply with the UK Data Protection Act 1998, your permission is needed before we are able to use an image or any likeness of your child. No image or likeness will be used without your permission. If it is given, you may remove your permission at any time by contacting Arts Centre Washington on 0191 561 3456 or [email protected] The agreement must not be signed by a minor (anyone under 18 years). Permission for a minor must come from a parent or legal guardian. (Required) I have read and understood the Media Consent terms and conditions.Media Consent I give my permission for the likeness of my child / ward to be used by Arts Centre Washington, Sunderland City Council and Sunderland Culture for the reasons specified above, until such time as I remove my permission. Arts Centre Washington Code of ConductArts Centre Washington expects participants to: Give their full commitment to the work of their Group. Show a willingness to participate in all activities and exercises. Work towards creating an environment that every member can work in. Respect and listen to the Group Leader. Respect all other Members of the Group. Respect all property belonging to Arts Centre Washington, Leader and other Group members. Be punctual, reliable and dress appropriately. Be considerate to tutors in the use of electronic devices (mobile phones, tablets etc.). Commit to attending all rehearsals when preparing for a production in order to ensure that this can go ahead (relevant to theatre groups). Arts Centre Washington will not accept: Discrimination, disruption, abuse, the possession of alcohol or recreational drugs and the use of items as weapons. Arts Centre Washington operates a 3 strikes system i.e. Warning by the group leader Warning by the Arts Centre management Contact made with parents to discuss child’s behaviour Any further behaviour that go against our Code of Conduct will result in the participant being asked to leave the group. Agreement for Young People I understand and agree to abide by Arts Centre Washington Code of Conduct:Agreement for Parents / Guardians I understand that during the period of the course my child will be in the charge of the leaders present and under their instructions. I accept that my child may be returned home if, in the opinion of the leaders in charge, they have behaved in a way which is unacceptable under normal circumstances.