Eclipse ‘Experience Week’ Booking Form How many places do you want to book?*1 child @ £952 children @ £171 (inc. 10% sibling discount)Child 1: Full Name* First name Last name Child 1: Date of Birth* DD MM YYYY Child 2: Full Name* First name Last name Child 2: Date of Birth* DD MM YYYY Your Full Name (Parent)* First name Last name Your Email Address (Parent)* Contact Mobile Number (Parent)*This number needs to be available during the Easter Experience week, if needed.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 street dance, gymnastics and cheerleading. 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). 3) 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.Order SummaryTotal £ 0.00 Credit Card* MasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.