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Use the form to book your child's first free Drama Class

Parent's Name

First Name

Last Name

Email Address

Emergency Contact Number 1

Emergency Contact Number 2

Select your child's school

Child's Name

Age & Year Group

Date of Birth

YYYY

Please send me information on upcoming classes.

Yes, I would like to be on your mailing list.

No, I do not want to receive emails.

Do you give us permission to photograph your Marketing and Social Media purposes? child/children for

Allergies (if any):

Medical Conditions (or medications being taken):

Does your child have any SEND or additional needs we should be made aware of?:

Anything else we should know

e.g. Allergies, additional needs

Authorised Adults

At Elizabeth Samuels, the safety and well-being of your child is very important to us. Please list all adults who are authorised to collect your child from class.

First Name

Last Name

First Name

Last Name

First Name

Last Name

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Book your free Class