Riverlea Theatre

Please complete as much information and provide as many contact details as possible.

Student Name:
Student Address:
Email Address:
Student's Home Phone:
Student's Work Phone (if appropriate):
Student's Mobile Phone:
Student's Date of Birth:
Mother's Name:
Mother's Home Phone:
Mother's Work Phone:
Mother's Mobile Phone:
Mother's Email:
Father's Home Phone:
Father's Work Phone:
Father's Mobile Phone:
Father's Email:
Which School do you attend?
Previous experience:	Please list previous experience below. This can be for Drama, Singing or Dance. Have you attended classes before? Do you play a musical instrument? Any other relevant information.
Medical Conditions:	Do you have any medical conditions we should be aware of? You may prefer to discuss this with the class tutor to provide more detail.
Emergency contact during classes:
Class you are enrolling for/Comments: