Tru Street Academy | TruStreetDance.com [BETA]

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To ensure we have the correct contact details for you, please fill out the following form and contact Management of Tru Street Academy to make a payment. As our online payment is not yet installed.

If you are a child or consider yourself to be a vulnerable adult (see * for further information) please ensure your parents/guardian/carer has signed the form before it is returned.

We will also use this information to ensure that you are kept informed about Tru Street Academy events.

Name: *

Full Name

Address: *

Postcode: *

Date of Birth: *

Home Telephone Number: *

Mobile Number: *

Gender: *

Male

Female

Email: *

Ethnicity Other:

If you selected other on ethnicity, please specify here

Welsh Language: *

In order to help the Tru Street Academy monitor its membership please will you tick one of the following boxes to identify whether you are a Welsh speaker.

Disability: *

Yes

The Disability Discrimination Act 2005 defines a disabled person as anyone with ‘a physical or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities.’

Nature of your disability:

If yes to Disability, what is the nature of your disability?

Medication:

Please note

We cannot administer medication under any circumstances unless previously agreed with the Tru Street Academy managemnet/volunteers.
A doctor’s note may be required.

You may be required to stay for sessions if:

Your child is new to the session
Your child is under the age of 7
Your child requires assistance with personal care
Your child may exhibit challenging behaviour

If you require any further information or clarification regarding the sessions or any other disability Dance issue please do not hesitate to contact:

Tru Street Academy Management

Have you Danced before?: *

Yes

Where have danced?:

If yes, where have danced (please indicate above)?

Primary School, Secondary School , Local Authority Coaching Session(s), Club , County or Other (please specify)

Further Dance Information: *

List Qualification:

If said yes to having qualification, please provide details:

Emergency Contact Name: *

Emergency Contact Number: *

Please insert the information below to indicate the person(s) who should be contacted in the event of an incident/accident.

Signature of Member: *

By ticking the following box i am digitally signing this Tru Street Academy form.

Date: *

Join Tru Street Academy: *

I/My child wish to join the Tru Street Academy course and agree to notify management a month before leaving the academy.

Dance and physical activity can and does play a major role in promoting inclusion of all groups in society. However, inequalities have traditionally existed particularly in relation to gender, race and disability. Tru Street Academy is committed to promoting and developing Dance equity, which is about fairness in Dance, equality of access, recognising inequalities and taking steps to address them. By monitoring the profile of young people in clubs, National Governing Bodies and the Arts councils can identify any issues relating to under-representation of different groups and can together develop strategies to ensure all young people have an opportunity in the future development and progress in Dance and physical activity.

Tru Street Academy Membership fees from January 2011 – March 2011 are at a special rate of £25 per month, after that fees will be at a rate of £30 per month.

Remember to phone the office to make a payment. Hope to see you dancing soon!

	No	Yes
Do you have a coaching qualification?
Do you have an official’s qualification?
Would you be prepared to become a volunteer helper at our Academy?