ACTiv8 Theatre

MEMBERSHIP OPTIONS *

First name of child 1 *

Last name of child 1 *

Child 1 date of birth *

Email Address (parent) *

First name of child 2

Last name of child 2

Child 2 date of birth

Parent's first name *

Parent's surname *

Photo and video permission *

I give permission for the public use of ACTiv8 images of my child
Please do not make ACTiv8 images of my child visible to the public

Home address and postcode *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Mobile phone number *

Landline or alternate phone number

Medical / Welfare 1 *

Please let us know if your child has an illness or condition that we should be aware of, or type NONE. If you need more space please use the boxes below. Thank you!

Medical / Welfare 2 (if needed)

Please use this box if you need more space

Medical / Welfare 3 (if needed)

Please use this box if you need more space