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I require extra hours on...
19th April 201720th April 201721st April 201731st May 20171st June 20172nd June 201724th July 201725th July 201726th July 201727th July 201728th July 2017

Child's Name

Date of Birth

Parent or Guardian's Name

Address

Email

Mobile Number

What year is your child currently in at school?

Does your child currently attend RPA sessions? If so, please select their class.

Does your child have any allergies?
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Details

I give permission for my child/ren to be photographed/videoed in class by RPA teachers to give feedback on performance skills

I give permission for my child/ren to be photographed/videoed in class by parents, family & friends during school performances

I give permission for my child/ren to be photographed/videoed at public performances (e.g. Steam, Big Arts Day, etc.)

I give permission for all of the above film & photographs to be used for marketing purposes on/in:

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