Eclipse ‘Experience Week’ Booking Form Your Full Name (Parent)* First name Last name Your Email Address (Parent)* Best Mobile Number (Parent)*This number needs to be available during the week.Child's DetailsChild: Full Name* First name Last name Child: Date of Birth* DD MM YYYY PRICES AND DATES Monday 6th to Thursday 9th April - first week of the Easter holidays9am-3pm every day EARLY BIRD DISCOUNT - If you book by Saturday 1st February at 10pm: x4 days £95 x3 days £75 x2 days £55 REGULAR PRICE - after 1st February at 10pm prices rise to: x4 days £115 x3 days £95 x2 days £75 Choose days you'd like your child to attend.*MIN 2 DAYS ---- MAX: 4 DAYS. Monday - Street & Lyrical Tuesday - Tap & Gymnastics Wednesday - Ballet & Street Thursday - Musical Theatre & Modern Number of Days4 Days (Early Bird Price until Sat. 1st February) Price: £ 115.00 3 Days (Early Bird Price until Sat. 1st February) Price: £ 95.00 2 Days (Early Bird Price until Sat. 1st February) Price: £ 75.00 Total £ 0.00 Consent* I agree to my child's participation in this experience week and I agree with the following terms and conditions.I am happy for my child to participate in dance classes including Tap & Modern, Lyrical & Disco, Singing & Tap, Street & Ballet and Modern & Musical theatre. All classes are taught by a qualified professional dance teacher. I acknowledge that, whilst Eclipse Dance will seek to take all due care and attention and to carry out suitable and sufficient risk assessments of all activities, there may remain residual risks and dangers inherent in the physical activity of dance classes which may result in injuries. As a parent/guardian I acknowledge this and am happy for my child to participate in the dance class at their own/parent’s own risk. I will observe the rules, regulations and instructions set out by Eclipse Dance staff. As is the nature of a dance class I knowledge that there may be physical contact between dance teacher and the child as appropriate to make corrections/improvements to their dance technique. This is normal practice in a class and I as a parent am aware and approve of this. (Please note all Eclipse Dance staff are fully DBS checked and have extensive experience in teaching children). Occasionally members of the Eclipse Dance staff may take photographs of children in class, rehearsal or performance. These will only be taken by a DBS checked Eclipse member of staff. As a parent/guardian, I am happy for photos to be taken to promote Eclipse Dance e.g. published on the Eclipse Dance website, Facebook page, posters/marketing etc. No names or personal details will be associated with these photos.Credit Card MasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged.