Full Name: *

Email Address: *

Address (with postcode): *

Mobile: *

Home Phone:

Emergency Contact (Name and Telephone Number): *

Do you have any disabilities, allergies or medical/learning needs we need to be made aware of:

Do you give permission for us to share medical/disability information with authorised staff if needed (e.g. your teacher). MTA only share medical/disability information when it necessary to ensure safety and/or participation in sessions. *
YesNo

Gender: *
MaleFemaleTransgender Male/Transman/FTMTransgender Female/Transwoman/MTFGender Fluid/Gender QueerNot ListedPrefer not to Say

Please complete for company funding purposes. Please specify ethnicity of student. *
—Please choose an option—White English / Welsh / Scottish / Northern Irish / BritishIrishGypsy or Irish TravellerAny other White background, please describeWhite & Black CaribbeanWhite & Black AfricanWhite & AsianAny other Mixed / Multiple ethnic background, please describeIndianPakistaniBangladeshiChineseAny other Asian background, please describeAfricanCaribbeanAny other Black / African / Caribbean background, please specifyArabAny other ethnic group, please describePrefer not to say

Ethnicity information is collected to provide information to funding bodies for statistical purposes. This data is always provided to third-parties as quantified data (i.e. numerical data only with no identifying information relating to any participant).

Other Ethnic Group

If you are new to Montage how did you hear about us? *
Internet SearchWord of MouthMagazine/Press AdvertFlyerYour SchoolOther

Please tell us where you got the information about Montage?

I accept that upon submitting this form that I agree to the Conditions of Membership. I authorise MTA to add the information on this form to the Members database. *
Yes

Read our Conditions of Membership

I am happy to receive infrequent information via email regarding further Montage courses, shows and events. *
YesNo

This data will be stored with GDPR compliant company MailChimp

I have read, understood and agree to Montage Theatre Art’s Privacy Notices. *
YesNo

MTA have my permission to take photos/video during classes, workshops, events and performances for the purposes of marketing, publicity and/or archiving. *
YesNo

These will never be shared with any identifying information (age, location etc.). There may be times where we will share first names, but only with consent.