OTMYT Seniors Application Form

1

Child's Name* This field is required.

First Name(s)

Last Name

2

Child's Pronouns* This field is required.

He / Him / His

She / Her / Her

They / Them / Their

Other

3

Child's Date of Birth* This field is required.

4

Child's Address* This field is required.

Street Address

Street Address Line 2

Town/City

County

Post Code

Country

5

Medical Consent* This field is required.Do you give consent for OTMYT to seek medical advice and/or treatment for your child, in an emergency?

YESNO

6

Medical/Special Educational NeedsPlease give details of any medical conditions or Special Educational Needs your child has; the information will be treated in the strictest confidence.

7

Your Details* This field is required.Please provide your contact details

First Name

Last Name

Email Address (this will be our main point of contact with you ongoing, so it should be an address that you check regularly)

Best Telephone Number

8

Alternative Emergency Contact* This field is required.Please provide details for a second emergency contact

First Name

Last Name

Email Address

Best Telephone Number

9

Policy Acceptance* This field is required.It is important that you have read and accepted the two following policies. If you haven't, please return to our website (www.otmyt.co.uk) and read them before continuing.

Yes, I have read it and accept it.

OTMYT Seniors Auditions, Attendance & Membership Policies

OTMYT Seniors Drop-off/Pick Up, Food & Drink and SEN/Medical Needs Policies

OTMYT Seniors Auditions, Attendance & Membership Policies

OTMYT Seniors Drop-off/Pick Up, Food & Drink and SEN/Medical Needs Policies

Yes, I have read it and accept it.

11

How did you hear about OTMYT Seniors?This information will really help us. (If more than one is true, please select the most appropriate)

If you selected 'Other' above, please give details here

12

Signature* This field is required.Please sign in this box, using your mouse/finger. You are declaring that the information on this application form is correct to the best of your knowledge and that you have read and accepted the policies mentioned on the previous screen.