Indigo Registration Form

REGISTRATION FORM

To be completed once you are attending workshops
I wish to join

young indigo Take 2 minimusic Indigo co.
Name of person joining Indigo

First Name Middle Name Last Name
Date of Birth

Month Day Year
Name of Parent/Carer if under 18 years of age

First Name Middle Name Last Name
E-mail
Contact Telephone Number:

Area Code Phone Number
Mobile:
Address:

Street Address

Street Address Line 2

City

Postcode
In case of emergency...
Emergency Contact:

First Name Last Name
Relationship
Telephone Number

Area Code Phone Number
Mobile Number

Area Code Phone Number
Please give details of any health/medical conditions / medications
Doctors name and Contact details
Consent given for use of image in photography / video / internet, for the purposes of indigo arts promotion, publicity and performance

Yes No
Name (Parent / Carer) if under 18 years

First Name Last Name Date
Charity Gift Aid Declaration - Do you want to boost any donation you give us by 25p for every £1 you donate?

Gift Aid is reclaimed by Indigo arts from the tax you pay in any tax year. Your address is needed to identify you as a current tax payer.

I want to Gift Aid any donations I make now, in the future, or have made in the last 4 years to Indigo arts.
Yes No N/A
I am a UK Taxpayer and understand that if I pay less income tax and/or capital gains tax than the amount of gift aid claimed on all my donations in that tax year, it is my responsibility to pay any difference.

Please notify Indigo arts if you:

• want to cancel this declaration

• change name or address

• cease to pay sufficient tax on your income and/or capital gains

If you pay income tax at the higher or additional rate, and want to receive additional tax relief due to you, you must include all your Gift Aid Donations on your self assessment tax return or ask HM Revenue & Customs to adjust your code.
Should be Empty:

REGISTRATION FORM

In case of emergency...

Charity Gift Aid Declaration - Do you want to boost any donation you give us by 25p for every £1 you donate?