Join our sessions I'm interested in: * Please select the session you are interested in joining Junior sessions (5-11) Senior sessions (12-18) Adult sessions (18+) Summer Schools Name * First Name Last Name Student Name If you are registering for someone else, please add their name here First Name Last Name Student Date of Birth * MM DD YYYY Student Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Contact Email * Please enter parent/guardian email if under 18 Contact Phone * Please enter parent/guardian phone number if under 18 Country (###) ### #### Does the student have any medical conditions? * Allergies, physical limitations etc. Yes No If yes, please provide details I give Perform Chepstow permission to use rehearsal and performance photos and videos of the above student for advertising purposes. * Yes No I give Perform Chepstow permission to seek medical intervention should emergency contacts be unavailable. * Yes No Emergency Contact 1 Name * First Name Last Name Relationship to student * Contact Number * Country (###) ### #### Emergency Contact 2 Name First Name Last Name Relationship to student Contact Number Country (###) ### #### Any other information you feel is relevant to the students' inclusion in our sessions How did you hear about us? Facebook Instagram Search Engine Word of Mouth Previous Shows/Events Posters/Flyers Friends/Family