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East Suffolk Stage Arts

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First name of primary contact

Address

Post code

Surname of primary contact

Relationship to student

Phone

Email

Are your billing details the same as your address details? *

Yes

No

Billing address (if different)

Student First Name

Student Surname

Student date of birth

Age of student

Gender

School attended

Any medical notes/special instructions we should be aware of?

Any allergies or dietary requirements?

Are you applying for siblings?

Please enter FULL NAME, DOB, GENDER and MEDICAL NOTES for any siblings you wish to apply for.

Please provide the full name of your secondary contact. We will use these details in the case of an emergency, if we cannot get hold of the parent/guardian.

Emergenct contact phone number

Relationship to student

Do you consent to photos/videos of your child/children being taken for purposes of promotion and sharing on social media? *

Yes

No

Would you like to receive email communication about fututre workshops? *

Yes

No

Are you applying for one of our scholarship placements? *

Yes - full scholarship

Yes - part scholarship

No

Where did you hear about us?

Do you have a discount code?

I accept terms & conditionsView terms and conditions

Thanks for applying! Check your email for coupons and details of what to do next.

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