Archestra Workshop |

Please complete the form below to sign up for the Archestra Workshop. Archestra is taking place on Tuesday 8th August, 2:00 - 4:00pm at Arch 27, Croft Road, Worcester, WR1 3BD.

Attendee details

Name*

First Last

Instrument*

Parent/carer details

Name*

First Last

Email address*

Phone number*

Emergency contact details

Emergency contact 1*

First Last

Phone number*

Emergency contact 2*

First Last

Phone number*

Parent/carer agreement

Parent/carer agreement*

I give permission for my child to participate in a Severn Arts outside of school activity.

Confirm

I confirm that I have parental/legal responsibility over the child*

Confirm

Parental consent

Emergency medical treatment*

Parental consent is required by Severn Arts should emergency medical treatment be needed whilst your child is participating in a Severn Arts activity. Please read our Parental Consent Agreement and confirm your consent below.

Yes - I consent to medical treatment
No - I do not consent to medical treatment

Filming and photography*

From time to time we may wish to take photographs or film children taking part in Severn Arts activities. See our Filming and Photography Consent for full details. Please confirm your consent below.

Yes - I consent to filming and photography
No - I do not consent to filming and photography

Medical information

Medical details

Please give details of any medical problems your child has, including both physical and mental health.

Doctor's name*

Doctor's phone number*

Doctor's address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Your privacy

Data consent*

The information you enter into this form will be collected and stored by Severn Arts. Please tick the tick box below to confirm you understand.

I understand

We will always store your personal details securely. We’ll use them to provide the service that you have requested, and communicate with you in the way(s) that you have agreed to. You can change your mind at any time by contacting us at [email protected] and by clicking the unsubscribe link in the Mailchimp emails you receive from us. Your data may also be used for analysis purposes, to help us provide the best service possible. For full details see our Privacy Policy By clicking 'Yes' below to subscribe to our updates you agree that we may use your information in accordance with these terms.

Keeping in touch*

We’d love to keep you posted with our news, events and activities. Would you like to receive updates from us?

Yes
No

I am particularly interested in:

Music
Arts & festivals
Cultural education updates for young people
Receiving the Arts Newsletter for practitioners

How did you find out about Archestra?*