Visit Dance House

Dance Days

Child or young person

First Name

Please enter your forename.

Last Name

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Age

Medical Info

Please give any information on any health problems/injuries/medical conditions/allergies. Please also state if your child or young person is currently on any medication

Parent or Guardian Information

First Name of Parent/Guardian

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Last Name of Parent/Guardian

Please enter your surname.

Email

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Telephone

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Second Emergency Contact

First Name of Parent/Guardian

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Last Name of Parent/Guardian

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Telephone

Please enter a contact telephone number.

NDCWales Media Permission

No

Yes

As the parents/guardians of the child or young person, do you give permission for NDCWales to use photographs or film taken for archival, documentation and marketing purposes?