confidential data sheet (Workshop)

please use a separate data sheet for each child

Child’s Full Name

Name “prefers to be called”

Date of Birth
Home Address

Postcode

Home Telephone Number ( )

Mother’s Name

Mobile Telephone Number ( )

Work Telephone Number ( )

Father’s Name

Mobile Telephone Number ( )

Work Telephone Number ( )

in the event of an emergency if we were unable to contact you on any of the above
numbers an additional contact would be helpful

Name Relationship to Child

Telephone Number ( )

The Man In The Moon uses an exciting way to communicate with members called
Solar. Solar is used to send out invoices, important information and newsletters via email,
significantly reducing the amount of paper we use, saving both time and the environment. We will
not share your contact details with anyone else
To use Solar we need an up to date email address that you regularly check. You will be asked to
confirm your details via email once you are subscribed. If you change your mind, you can opt out
by clicking the link at the bottom of the emails we send. You will no longer receive emails from us

Your Email Address

Please cross here if you do not want to use Solar. We will send all information home in
paper format. However, you will not receive up to date alerts or special offers this way
now, please turn over
Care Information
please give us details of any allergies, illness, special needs, dietary restrictions, etc.

Payment
Fees are payable in advance and are non-refundable. They are due on or before the beginning of
the new term. Payment after this incurs a 10% administration charge. Interest at the rate of 2% per
month is charged on accounts which remain excessively overdue
Hoodies
A theatre company hoodie or equivalent must be worn to all activities
Insurance
We hold full cover for public liability. However, we do not accept responsibility for any personal
property that becomes lost or damaged
Medical
In the event of illness or accident you will be contacted immediately. If this is not possible, your
child will be taken to hospital
Behaviour
High spirits are welcomed, but if a child is continually disruptive, we reserve the right to suspend
or exclude them. No refund will be given
Equal Opportunities
Our workshops are open to any child regardless of gender, race or disability, subject only to
availability of places
Leaving
We must receive written notice before commencement of the new term if a child wishes to stop
attending workshop. If this is not received, half a terms fees are payable

Parent / Carer Signature

Date

The Man In The Moon : : 9 Beacon Hill Road : : HINDHEAD : : GU26 6NR
Telephone / Fax: 01428 608866 : : www.themaninthemoon.co.uk 08/06