PARTICIPANTS - EMERGENCY CONTACT FORM

MK DANCE THEATRE

PARTICIPANTS 26/27
EMERGENCY CONTACT FORM

Emergency Contact Form

For dancers under 18, this form must be completed by a parent or guardian. A dancer aged 18 or over may complete the form themselves.

Dancer: first name

Dancer: surname

Emergency Contacts

Please provide the name (s) of the person (s) MK Dance Theatre should contact in case of an emergency.

Emergency contact (1): full name

Emergency contact (1): phone number

Emergency contact (1): relationship to dancer

Emergency contact (2): full name

Emergency contact (2): phone number

Emergency contact (2): relationship to dancer

Medical, allergy & medication information

Only provide information that MK Dance Theatre needs to help keep the dancer safe during rehearsals, events and performances.

Allergies (write ‘None known’ if none)

Medication, dosage and administration information (write ‘None’ if none)

Medical conditions, injuries or additional health information (write ‘None’ if none)

Emergency action plan or other relevant safety information

I explicitly consent to MK Dance Theatre collecting and using the medical, allergy and medication information provided in this form solely to support the dancer’s safety and wellbeing during MK Dance Theatre activity.

Full name of parent / guardian or dancer aged 18+ (electronic confirmation)

MK DANCE THEATRE

PARTICIPANTS 26/27 EMERGENCY CONTACT FORM

Emergency Contact Form

Emergency Contacts

Medical, allergy & medication information

PARTICIPANTS 26/27
EMERGENCY CONTACT FORM