Member's Name
Address
Postcode
School / College
Home Phone Number
Parent's Emergency Mobile
Member's Mobile Number
Member's Date of Birth
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Date
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Month
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Year
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Any medical information we should have
(please tell us about diabetes / epilepsy / asthma / dyslexia / dyspraxia / aspergers / autism)
Member's email address
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Your Start Date
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. Day
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Date
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Month
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Year
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Which session do you wish to join. Please select an area, then the session.
Please only select one
Chatham (Spotlites @ Kings Theatre)
Maidstone (Spotlites @ Brunswick House)
Gravesend (Spotlites @ Riverview School)
Sittingbourne (Spotlites @ New House Centre)
------------------------------- Consent Section -------------------------------
Can we & the press take photos and video of your child Yes or No
I give permission for my child / self (if over 18 years) to take part in Spotlites Workshops.
I accept that whilst every care will be taken this will be at my own risk. Yes or No
I have read and accept Spotlites rules (click here
to read the 'Spotlites rules 1 to 3') and agree to give 4 weeks term time week's notice or pay £18 in lieu to stop my membership when the time comes. Yes or No
Should the necessity arise, I give permission for an anaesthetic to be administered to my child (self if over 18 years) or for any other urgent medical treatment to be given. Yes or No
I give permission for these details to be kept on Spotlites' database to aid emergency contact. Yes or No
Parent's Signature (print name)
Name of Parent / Guardian who completed this form
Parent's email address
Please click send below,
you will then be redirected to the payment page
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