Name: Junior Associate Programme Registration and Payment Form
SKU: 25486
Availability: InStock

Student Details

First Name*

Surname*

Address*

Post code*

Date of Birth*

Gender*

Please specify*

Please select level attending*

Pre-Prep 1
Pre-Prep 2

Course

Education*

Dance school*

Current dance teacher*

Dance teacher's email address*

I confirm that I have the dance teacher's permission to share their email address with Central. This email address will only be used only in connection with the Associate Programme and Teacher Development opportunities.*

Yes

Parent/Guardian Details

Name*

Email address*

Telephone*

Emergency contact details

Name*

Relationship to the student*

Contact telephone number*

Please provide a mobile number if possible

Permission to Leave the Premises

We are responsible for the safety of pupils only whilst they are on the school premises, but we do insist that all students aged 18 or under who wish to leave the premises at lunchtime, during breaks or travel alone have permission to do so. If you are happy for your child to leave the premises either during breaks (if applicable) or to travel alone whilst attending Central School of Ballet, please tick below.

Do you give permission for your child to leave the building during breaks and travel alone whilst attending the Associate Programme during this academic year 2023/24?

YES, I give permission
NO, I do not give permission

Equality and Diversity Information

Central School of Ballet is committed to addressing issues of under-representation in ballet and higher education. To achieve this, we identify and target prospective, talented students from groups that are currently under-represented, particularly including students:

from low income backgrounds
from postcodes where participation in higher education is low
from under-represented ethnic backgrounds
students classified as having a disability

In answering the questions below, and throughout this form, you will enable us to work towards ensuring talented dance students can access ballet and higher education. For further information about Widening Participation at Central School of Ballet please follow this here

Ethnicity*

Disability*

Did either of the student's parents attend Higher Education?*

I prefer not to say
Yes
No

Is the student, or has the student ever been, in local authority care?*

I prefer not to say
Yes
No

Is the student estranged from their parents?*

Estrangement is defined as having not communicated with either of their biological or adoptive parents for the past 12 months and the situation is irreconcilable, or their parents cannot be traced, or it is not possible, practical, or safe to contact them or that their parents have significant mental or physical health problems which prevent the student from contacting them.

I prefer not to say
Yes
No

Household Income*

Injuries & Medical Conditions

Please specify any ongoing medical conditions, allergies and recent injuries and relevant treatment.

Disclaimer*

I understand that the information I provide on injuries and medical conditions will be processed by appropriate individuals only in accordance with access protocols (i.e. on a ‘need to know’ basis). I can withdraw my consent at any time by emailing juniorschool@csbschool.co.uk

Additional Needs & Resources

Will the student(s) need additional support for any reason?*

Yes
No

• By informing us of any additional needs, this means that we can look at any extra support that is needed and make sure it is in place before your child starts class with us. This is to ensure they are safe, well cared for and most importantly happy in class. The support may be for health or medical requirements, learning difficulties or behaviour. These could include medical treatment, assessments by a speech and language therapist, medical staff, psychologist or psychiatrist and concerns about development or behaviour. All information disclosed is confidential and will only be used to decide whether your child needs additional help or resources.

If yes, please provide more details below:*

Photography Permission

Central School of Ballet may take photographs and/or film footage in classes which will be used at the discretion of Central School of Ballet, the Conservatoire of Dance and Drama and partner organisations on social media and future marketing campaigns. To comply with the General Data Protection Regulation (GDPR) and the Data Protection Act 2018, we need your permission before any images of the applicant (aged under 18) are taken. Please note, names of children will not be printed alongside photographs.

Please select one of the following*

YES, I give permission for the student(s) to be photographed and/or filmed during classes, and for the resulting images to be used by Central School of Ballet, the Conservatoire of Dance and Drama and partner organisations.
NO, I do not give permission for the student(s) to be photographed and/or filmed during classes, and for the resulting images to be used by Central School of Ballet, the Conservatoire of Dance and Drama and partner organisations.

Marketing Preference

Mailing List

If you would like to be contacted about future Widening Participation opportunities and events at Central School of Ballet, please tick one or both boxes to specify what you wish to receive. Please note that you must be aged 18 or over to receive emails from Central School of Ballet. (If you do not wish to receive emails regarding other opportunities, please leave these boxes blank. Please note that you will therefore only receive emails about courses for which you attend.)

I would like to receive further details about Widening Participation opportunities at Central School of Ballet.
I would like to hear more about Central School of Ballet and Ballet Central, including news, fundraising, forthcoming events and wider opportunities.

Long-term evaluation

Central School of Ballet may wish to contact you to assess the long-term impact of our work. Do you consent to being contacted?*

Yes
No

Please provide the email address where you would like to receive these updates*

Declarations

Please tick this box to say you have read and agreed to the Data Processing Statement here

I certify that to the best of my knowledge the information provided in this document is accurate at the time of writing. I accept that any amendment to the information provided after acceptance and acknowledgement of this application could result in the loss of a place. I have also read and understand the Payment and Refund Policy detailed here

I confirm I give my explicit consent for the information I have provided in this form, including any information on injuries and medical conditions, to be processed by appropriate individuals only in accordance with access protocols. I can withdraw my consent at any time by emailing juniorschool@csbschool.co.uk

Parent / Guardian Signature*