Tip Tops

Children's Consent Form

Name of Child *

Address *

Date of Birth *

Emergency Contact 1 *

Relationship to Child *

Telephone Number *

Emergency Contact 1

Emergency Contact 2 *

Relationship to Child *

Telephone Number *

Emergency Contact 2

Any Illnesses or Allergies *

Please give as much detail as possible

Name and Address of Doctor *

Any Physical and/or Learning Disabilities *

Please give as much detail as possible

I give consent for my child to be photographed and placed on the social media sites of Tip-Tops *

I give my consent for my child to be part of Tip-Tops Dance Classes/ Workshops/ Holiday Clubs. *

If there are any problems I will contact Danielle or Georgia immediately.

Consent given by *

Insert Name

Date *

Date of consent