C/OMarina Studios, 11 Mermaid Walk, Brighton Marina Village, Brighton BN2 5WA
01273 978105 / /
Membership Form – Today’s date…………………………………
BLOCK CAPITALS PLEASE
Student’s Name: ______
Gender: (please circle)MaleFemaleOther
Date of Birth: ______
School child attends: ______
Parent/Guardian’s name: ______
Address including postcode: ______
______
Emergency Tel. No. 1:______
Emergency Tel. No. 2:______
Email address:
Please note all correspondence, including essential class information, will be provided by email and text message ONLY, therefore please ensure we have the correct email address and mobile number for you.
HOW DID YOU HEARABOUT US?
/ Argus /
Website /
Google /
Outdoor maps /
Flyers /
Passing by /
Events /
If there are any medical conditions that you feel are relevant, please specify here:
______
______
If a minor injury is sustained, do we have permission to administer a plaster?
YESNO
In an event of an emergency do we have permission to perform emergency first aid including CPR
YESNO
Please refer to the terms and conditions overleaf for our Health and Safety terms.
From time to time we take photographs/video at the course that may be used for marketing and promotional purposes including social media for Streetfunk. If you would rather you/your child was not included in any photographs we must be informed in writing before the course. Signature of this form constitutes your consent to take and use these pictures/video.
Your/Parent’s signature:______Date: ______
TERMS AND CONDITIONS
1. Payment
Payment of the deposit/contract amount will confirm acceptance of the terms & conditions by everyone on the booking form. Classes cost £8/class). Fees are payable termly in advance.
2. Balance
Streetfunk offer 1 trial session, after which the full term fees are payable if you/your child wishes to continue.
4. Confirmation
Prior to the course commencing you must confirm your place with the office via email. Please check the details including dates and location, and let us know within 14 days if we haven’t confirmed what you expected.
5. Cancellations & Customer Protection Plan
Cancellations must be made in writing.
You may cancel for any reason up to 1 week before the course start date and receive a full refund.For cancellations within the first 2 weeks of the course start date, we will refund you for the remaining weeks of the course after written cancellation is received. Please note that we cannot offer a refund in the case of illness or injury unless your child is unable to participate in all subsequent weeks of the course. All such claims will need to be supported by a doctor’s note.
6. Photography
From time to time we take photographs/video at the course that may be used for marketing and promotional purposes, this will include all social media formats. Videos and photos may be taken and posted immediately.If you would rather you/your childwas not included in any photographs we must be informed either at the time of booking or in writing before the course. Signature of this form constitutes your consent to take and use these pictures/video.
7. Health and safety
In order that we maintain appropriate standards of health and safety, you are responsible for disclosing any prior medical or physical conditions on this form and also to the teacher before the class starts. If you are in any doubt as to the suitability of the course please consult your doctor. You expressly acknowledges that engagement in dance whether under the care and supervision of Streetfunk in the course of tuition or as a matter of free form dance in social dance engagement, is a physical activity of medium to high aerobic demand AND that engagement in dance may occasion falls, sprains or twisted ligaments, respiratory or cardiovascular stress (in persons with respiratory or cardiovascular disabilities). The attendee (or parent/guardian) covenants with Streetfunk that the attendee has sought all appropriate medical advice prior to the acceptance of this invitation to ensure the Client is in good physical condition fully able to undertake the aerobic demands of dance (including without limitation fast tempo modern dance) at the date hereof AND FURTHER the Client accepts and assumes ALL RESPONSIBILITY for any loss, damage, injury or adverse consequence suffered by the Client as a result of engaging in dance AND INDEMNIFIES Streetfunk absolutely in respect of any claim by or through the Client in the event of injury to or demise of the Client as a consequence of engaging in dance excluding only loss or damage suffered as the direct consequence of negligent breach of duty of care by Streetfunk. The client acknowledges that some physical contact may be necessary by course instructor
8. Medical information
The membership form includes a section to inform us of any activities a child may not be able to take part in, the reason why, and any medical or physical conditions or behavioural problems. If full information is not provided this may result in the child being excluded from certain activities. In such circumstances no refund will be paid and we may have to cancel the booking. All information given will be treated in complete confidence.
9. Liability
Streetfunk does not accept liability for personal injury or the death of any participant unless directly caused by the proven negligence of the company or its servants. Streetfunk accepts no liability of any property or belongings of any students, or visitors.
10. Exclusions
If an attendee is persistently disruptive, or if we feel their attendance affects the good atmosphere of the course, we may decide to exclude them. Transport home will be the responsibility of the parent/guardian and no refund will be made for days missed or cost of transport.
11. Programme changes
In some circumstances, such as unsuitable failure of equipment, building faults and other factors (Incl. force majeure) which may arise from time to time, we may have to amend our services and activity programme content, times, dates and venue. In these circumstances there will be no refund or compensation to the customer.
12. Data Protection
Streetfunk acts as a Data Controller for the purposes of the Data Protection Act 1998. We need to collect some personal details from you and the children on your booking so we can process your booking, such as names, ages and any applicable medical or dietary restrictions and, in some cases, credit/debit card or other payment details. It is your responsibility to ensure that you have the necessary permission to pass on the personal details of all the children that you are making a booking for.
Additionally, we would like to hold and use some of your details for future marketing purposes, for example sending you promotional information. Please let us know as soon as possible if you do not want to receive future mailings from Streetfunk by ticking here