Dancer's Details Dancer's Name (first and last) * Date of Birth * Age (on 1st September 2021) * Gender * Male Female Identify as other Prefer not to say Address (House No. Street Name) * Town/City * Postcode * Local Authority * Lancashire Blackburn with Darwen Blackpool Other Parent/Guardian Email Address (if Under 18) Dancers Email * Schools/College/University (from 1st September 2021) * Emergency Contact and Medical Details Emergency Contact Name - Person 1 * Emergency Contact Number - Person 1 * Emergency Contact Name - Person 2 * Emergency Contact Number - Person 2 * Medical Details *
Please list any medical conditions, allergies and/or current medication being taken
Name and Address of Doctor * Help us get to know you Dance Experience *
Let us know your previous dance experience and any other dance schools/groups you perform with (don't worry if you don't have any!)
Why do you want to become a member of Preston Youth Dance Company? *
Give us a sense of what you want to gain from your experience in the company.
The Other Stuff How did you hear about us? *
Tick all that apply
Do you wish to be added to the Blue Moose Dance mailing list? We don't spam you! Just share any upcoming events and projects you may be interested in! * Yes please, sign me up! No thanks Photo, Moving Image and Case Study Consent
We would like to use photographs and film of you, as well as information you provide about yourself in case studies, to populate printed and digital marketing material, success stories, testimonials and for use on social media. You can consent to Blue Moose Dance using photographs and film of you and/or content from case studies by ticking the relevant boxes below. In the case of young people aged under 18, we require consent from a parent or guardian on their behalf and adhere to protect the young person through our Child Protection Policy.
If you provide your consent below, you are agreeing that Blue Moose Dance can use your images in photographic and film format and/or content from case studies about you in any type of marketing materials including (but not limited to) Blue Moose Dance websites, websites of other affiliated organisations, on and offline publications, public relations messages and other advertising, such as social media, brochures, information leaflets, adverts, posters and other formats to promote Blue Moose Dance and its activities. You agree that the photographs, film and/or case studies may be used in this way without payment or further contact from Blue Moose Dance, for the foreseeable future. Please note that your photographs/film/case studies may be used together or may appear individually.
Photographs, film footage and case studies will only be used by Blue Moose Dance and any affiliated parties within the specific project they were taken and will not be passed to third parties for marketing purposes.
If you would like further information, a copy of this form or to tell Blue Moose Dance that you no longer want your images and/or case studies used in the ways outlined above, please contact Sarah Hall on firstname.lastname@example.org
If OVER 18, please select from the options I agree to my photograph/moving image being taken/recorded and used in marketing, publicity and reporting by Blue Moose Dance. I DO NOT agree to my photograph/moving image being taken/recorded and used in marketing, publicity and reporting by Blue Moose Dance. If UNDER 18, please ask a Parent/Guardian to select from the following options: I agree to my child/ward's photograph/moving image being taken/recorded and used in marketing, publicity and reporting by Blue Moose Dance. I DO NOT agree to my child/ward's photograph/moving image being taken/recorded and used in marketing, publicity and reporting by Blue Moose Dance.
Blue Moose Dance Company works across 2 antlers, Blue Moose LTD and Blue Moose Dance Company CIC, allowing us to spread the dancing joy even further!
Blue Moose LTD, Registered Company No. 10963231
Blue Moose Dance Company CIC, Registered Company No. 09343271
We create opportunities for people of all ages, backgrounds and abilities
to see, make and take part in high quality dance.
What we’ll do with your details
We’ll store your details securely, in compliance with General Data Protection Regulation (GDPR), the law that obliges us to keep your details safe.
We may occasionally contact you about our activities if you have given us permission above.
We use our audiences’ and participants’ anonymised details to show our stakeholders and funders how and where we’re using their money, and what kind of people are benefiting from our work.
If you have any questions please e-mail email@example.com