Youth Music Theatre UK - 2017Musical Theatre Club Booking Form

By filling out this form, it is understood that you will be attending the club each week. Please email: or phone: 02085637725 if you need to discuss this further.

Full Name
Age / yrs / months / Date of Birth / / /
Gender
Address
Postcode
Home Phone no. / Mobile no.
Email(To receive your booking confirmation and any future correspondence about YMT)
Emergency Contact Name
Emergency Contact Email
Emergency
Contact Number
Relationship to Young person
School Name
Have you been a part of YMT before?
Do you play any instruments?
(please indicate grades)
How did you hear about the club?
How would you describe your ethnic origin? (please tick one)
 White British
 White Irish / White Other
 BAME (Black, Asian, Minority Ethnic) /  Mixed Race / BAME (Black, Asian or other Minority Ethnic)
Do you have any special needs or access needs? (e.g. asthma, wheelchair user, dyslexia, ADD, allergies etc.)

When is it happening?

Apr: 25 May: 2,9,16,23 Jun:6,13,20,27 Jul: 4,11,18

What do I bring?

Please wear loose/sports clothing, NO jeans

Please bring a water bottle and snack

What is the cost?

£5- per session

£15- for 4 sessions

£45- for the term

How can I pay?

  1. Pay on the door with CASH
  2. Book through YMT via debit/credit card
  3. Complete postal application send/email to

Payment Details

PAY ON THE DOOR: Please arrive with £5 CASH for your session admission.

If you provide us with these details we will take a payment of £5.00 each week until the end of term dates, unless we are told otherwise.


PAY BY DEBIT/CREDIT CARD:We accept all major credit/debit cards except American Express. Please note that unlike many organisations, YMT does not charge extra for accepting payment by credit card. However, we do prefer to receive payments by debit card where possible, as related bank charges are much lower than for credit cards.

Name of cardholder
Debit/Credit Card number
Start date / End date
Validation number
(last 3 numbers on the signature strip) / Issue number (Maestro only)
House no. of card-holder / Post Code of card-holder

Data Protection Act (1998) The information you supply on this paper based documentation will be securely retained at the YMT office until completion of this payment plan. Upon completion, the paper copy will be destroyed. We are required to keep a digital (secured) copy for statutory and audit purposes only.

Signature ofParent/Carer
Print Name / Date / / /

Please return your form to - Youth Music Theatre UK, The Hub, St Alban’s Fulham, 2 Margravine Road, London, W6 8HJ

PLEASE TURN OVER