Show Permission Form - Iconic

To be filled out by Parent / guardian (one form for each child)

Childs First name

Childs Last name

Date of Birth

Day

Month

Year

Email

Emergency Contact Details

Contact First Name

Contact Last Name

Contact Phone Number

Any Medical information that you feel is appropriate

I confirm that my child is fit and well enough to take part in this years show

Costume

I understand that I will be responsible for providing an appropriate costume for my child based on the act/theme. I will ensure the costume allows full movement and does not include any sharp objects, large buttons, zips, or anything that could cause injury or damage equipment

Programme, Show filming and agreements

I agree to my child being photographed. I am aware that this may be used for promotional purposes

I agree to my child being filmed for the show video. I am aware that this may be used for promotional purposes

I give permission for my Childs name to appear in the show programme and end credits of the video

Show dates

This years show will run July 6th - July 11th with students performing on their usual class days:

Mondays classes will perform on Monday - July 6th

Tuesdays classes will perform on Tuesday - July 7th

etc

Each class will perform two shows on their evening

By ticking this box I confirm that it is a commitment to rehearsal / all show dates (on usual class days)

I understand and accept that the show fee is non-refundable

Signature

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Academy Of Movement

1A Boldero Road, Bury St Edmunds, IP32 7BS

info@academyofmovement.co.uk

Contact Us

Please complete the below form by: 27/04/26

Show Permission Form - Iconic

Emergency Contact Details

Costume

Show dates