Arts Inc Academy
BOOKING FORM
Please complete ALL sections of this application as fully as possible, using BLOCK CAPITALS and return
to: Ailsa Lane, GDance, Colwell Arts Centre, Derby Road, Gloucester, GL1 4AD
ailsa@gdance.co.uk
All information provided will be treated in the strictest confidence. If you need help or advice when
filling in this form please do not hesitate to call GDance on 01452 550431
DETAILS of participant
Full Name
Gender (M/F)
Date of Birth
Home Address
Postcode
Home Telephone
Mobile
Email address
How did you hear
about this opportunity?
Have you / has your
YES / NO (please circle)
child participated in
If yes, please state which activities and what organisation provided them:
Arts Inc clubs or other
arts activities
previously?
Other information?
Please give us any information you may feel it useful for us to know about your child. I.e. Health,
mobility, medication, any social, religious, cultural or special needs or protocol we should be aware of
when dealing with your child. Please do provide any further details if necessary on a separate piece of
paper. This will help us to plan your child’s involvement in the academy.
PARENT/GUARDIAN DETAILS
(To be completed by a parent/guardian. Where details are the same as above please note with N/A)
PARENT/GUARDIAN 1
PARENT/GUARDIAN 2
Full Name
Relationship to the
Participant
Home Telephone
Work Telephone
Mobile
Email address
DATA PROTECTION
A) We use this information to report to funders and to promote our own arts activities. The Arts Inc
partners (Art Shape and GDance) do not pass your data on to third parties unless we have your written
permission. Personal data will not be kept on our files for longer than 6 months after your last session
with Art Shape and/or GDance. Applicants’ details will be added to our database from which they may
receive email newsletters about local arts opportunities. If you do not wish to be added to our mailing
list or receive text updates, please tick the box. 
B) Photography and video images will be taken during the course. These are used for learning,
promotional and reporting purposes. Images may appear in printed marketing material, in the
press/newspapers or on the Arts Inc, Art Shape’s and/or GDance’s website and online social media
pages (e.g. Facebook page)*
* Guidelines and safeguarding information is available on request
PAYMENT
£30 for each 6 week block.
Payment is by cash or cheque only and is payable in advance of the first session. (Payment plans
available with prior arrangement)
NB. All monies paid to partake in GDance activities are non-refundable.
Please make cheques payable to Gloucestershire Dance
MONITORING
Arts Inc requires information on ethnic culture/ background for funding and monitoring purposes.
Please write below how you would describe the ethnic origin of your child:
SIGNATURE
Signed:______________________________
Date:_____________________
We will contact you once we have received your application form to confirm your child’s place.