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Ariel Othellos Buddies Musicality 2026
Application Form
Students First Name
Students Surname
Date of Birth
*
required
Parent/Guardian First Name - Emergency Contact
Parent/Guardian Last Name - Emergency Contact
Email
Emergency Contact Phone Number
Address Line 1
Address Line 2
Address Line 3
Town
Post Code
2nd Emergency Phone Number - Diffrent to Phone Number Above
2nd Emergency Contact Name
Relationship to student
What Academy do they attend?
Please Select
Do you give permission for the student to leave the workshop unattended
*
YES
NO
Do you give permission for the student to leave the workshop at Lunch time unattended
YES
NO
Medical conditions/allergies - please include instructions with regards to medication that may need to be administered. For allergies, please state what action should be taken in an emergency. Emergency Contact Details.
Has your child had any serious illness, operation or accident in the last year? If so, please give details.
Has your child had any illness during the past year? If so please give details.
Does your child have any difficulty with a) hearing or b) eyesight
Does your child require any medicines, or special treatment about which the Organisation should be informed? If yes, please give details with instructions/actions that need to be taken in the event of an incident.
Are there any other considerations Ariel should be made aware of? If yes, please give details with instructions/actions that need to be taken
Your Signature
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I have read and accept the terms and conditions
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Othellos Spring Musicality 2025
Othellos Summer Musicality 2024
ariel-othellos-buddies-musicality-2026
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