Irish Dance-Free taster session

MIDA-Free Taster Session

Saturday 13th April 2019

10am-11am

McKeown Irish Dance Academy

North Hull Community Centre

37th Avenue

Greenwood Avenue

HU6 8AU

Name of parent/guardian *

First Name Last Name

Child's Date Of Birth *

Name of emergency contact *

First Name Last Name

Relationship to child *

Emergency contact phone number *

Does your child have any previous/existing medical condition? *

Yes No

If you answered yes, please describe below

I consent to my child’s photograph being taken for promotional purposes of the McKeown Irish Dance Academy and its partners.

First Aid Statement: Unless there is good reason, First Aid will not be administered without permission of the child’s parent/guardian. If the parent is not at the premises, we will try and make contact via the emergency contact details provided on this form. However, if a child is unsupervised and seriously injured or unconscious, the situation will need to be dealt with immediately. If at all possible, treatment should only be given by a trained First Aider.

I have read the above First Aid Statement and I consent that in the circumstances described, teachers and staff can administer First Aid to my child.

*

I have read the above First Aid Statement and I consent that in the circumstances described, teachers and staff can administer First Aid to my child.

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