8-16 Years Central Moves Application Form

Applicant's Details
First name*
Surname*
Is the applicant a current Junior School/Associate Programme student at Central School of Ballet?*
- Yes
- No
Which class(es) does the applicant attend?*
Address*
Post Code*
If you live in London, please specify in which borough
If you are a Southwark resident and would like to receive the 20% Southwark discount, please tick this box.
Please note, by ticking this box you are confirming that your permanent place of residence is within Southwark. You will be asked to present proof of address when arriving at Central School of Ballet and before the attending student checks into the course.
In order to access the discount, after completing this form you will receive an email containing a coupon code. Please wait to make payment for the course until you have received this email.
- I am a Southwark resident and would like to receive the 20% discount
Date of Birth*
DD dash MM dash YYYY
Age*
Please enter a number from 8 to 16.
Current School Year*
Gender*
Please specify*

Parent / Carer Details
First Name*
Surname*
Email address for all correspondence*
Telephone*

Emergency contact details for the duration of the course
Name*
Relationship to the applicant*
Contact Telephone Number*
(Please provide a mobile telephone 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 Central School of Ballet?
- YES, I give permission
- NO, I do not give permission

Education Details
Education*
Name of school or college
Address
Post Code

Dance Training
Dance School(s) (if applicable)
Name of Dance School Address Dates Attended Hours of Training Per Week
Please tell us if the applicant has studied any of the dance genres below
- Ballet
- Pointe
- Modern
- Tap
- Contemporary
- Jazz
- Street
- Hip-hop
- Ballroom
- South Asian
- Other
Please specify
Please provide details of the highest grade achieved in each dance genre
Has the applicant previously attended any Central School of Ballet courses or auditions?*
- Yes
- No
If yes, please specify which courses/auditions*
How did you hear about this course?*
Please specify*

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 participation@csbschool.co.uk

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 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 applicant to be photographed and/or filmed during classes, and for the resulting images to be used by Central School of Ballet and partner organisations.
- NO, I do not give permission for the applicant to be photographed and/or filmed during classes, and for the resulting images to be used by Central School of Ballet 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.
Please provide the email address where you would like to receive these updates*
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
Declarations
*
- Please tick this box to say you have read and agreed to the Privacy Policy 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 participation@csbschool.co.uk
Once you click submit, you will be redirected to payment. Please note, a place on this course will not be reserved for you until payment has been received. You will also receive an email confirming that a place has been reserved for you on the course. If you do not see this confirmation in your emails, please check your junk/spam folder for an email from Central School of Ballet.
Parent / Carer Signature*

8-16 Years Central Moves Application Form

Step 1 of 10 – Applicant’s Details

Applicant's Details

Parent / Carer Details

Emergency contact details for the duration of the course

Permission to Leave the Premises

Education Details

Dance Training

Injuries & Medical Conditions

Photography Permission

Equality and Diversity Information

Marketing Preference

Long-term evaluation

Declarations

Name of Dance School	Address	Dates Attended	Hours of Training Per Week