Student Registration 2024 Student Details Student - Legal Full Name * First Name Last Name Student - Preferred First Name Student - Pronouns * She/Her He/Him They/Them Student - Gender * Female Male Non-Binary / Prefer not to say Student - Date of Birth * MM DD YYYY Student - Address (address student will live during their training) * Address 1 Address 2 City State/Province Zip/Postal Code Country Student - Mobile Phone Number * (###) ### #### Student - Email Address * Student - Ethnicity * White: British White: Irish White: Traveller of Irish Heritage White: Gypsy / Roma White: Other Mixed: White and Black Caribbean Mixed: White and Black African Mixed: White and Asian Mixed: Other Asian or Asian British: Indian Asian or Asian British: Pakistani Asian or Asian British: Bangladeshi Asian or Asian British: Other Black or Black British: Caribbean Black or Black British: African Black or Black British: Other Chinese Other Ethnic Group Student - Nationality * Student - Religion * Catholic Christian Hindu Jewish Muslim Sikh No Religion Medical Information Please provide details of any medical conditions that the Academy should be aware of, and any emergency action that should be taken (e.g. Asthma, Epilepsy, Allergies, nuts or particular medicines, etc.) Doctor / Medical Practice Name * Doctor / Medical Practice Phone Number * (###) ### #### Do you give the Academy permission to call the doctor in an emergency? * Yes No Do you give the Academy permission to administer First Aid in an emergency? * Yes No Parent/Carer #1 Details Parent/Carer #1 - Full Name * First Name Last Name Parent/Carer #1 - Relationship to Student * Mother Father Carer / Guardian Foster Parent Step Mother Step Father Social Worker Other family member Parent/Carer #1 - Email Address * Parent/Carer #1 - Mobile Phone Number * (###) ### #### Parent/Carer #2 Details Parent/Carer #2 - Full Name First Name Last Name Parent/Carer #2 - Relationship to Student Mother Father Carer / Guardian Foster Parent Step Mother Step Father Social Worker Other family member Parent/Carer #2 - Email Address Parent/Carer #2 - Mobile Phone Number (###) ### #### Emergency Contact Details Emergency Contact #1 - Full Name * First Name Last Name Emergency Contact #1 - Relationship to Student * Emergency Contact #1 - Phone Number * (###) ### #### Emergency Contact #2 - Full Name * First Name Last Name Emergency Contact #2 - Relationship to Student * Emergency Contact #2 - Phone Number * (###) ### #### Fees and Invoicing Invoices are sent on the 1st of the month and due for payment within 7 days of issue. Preferred Payment Plan Termly (3 Instalments) / per year 10 Monthly Instalments / per year 12 Monthly Instalments / per year Consents Fitness to Train - in my opinion, the student named on this form are fit and able to commence our rigorous training, which include various vocal techniques and movement and dance styles. * Yes No Photography/Filming - Staged Productions & Events - Do you consent to the student being photographed or filmed for Platinum Academy productions/events? * Yes No Photography/Filming Publishing - Do you consent the use of the student's photo/video being published on our online platforms? This may include our website, social media channels and newsletters. * Yes No Printed Publications - Do you consent the use of the student's photo being published in our printed publications? This may include our Prospectus and/or marketing resources. * Yes No Publishing of Name & Photo - Do you consent to the use of the student's name being published with a press photograph? * Yes No Declaration The information provided in this form is correct, true and accurate. (Please notify the Academy in writing as soon as any changes to this information occur). We understand that the application may be withdrawn if any of the information provided is inaccurate, false or incomplete. * I agree that the information provided in this form is correct, true and accurate. You agree and acknowledge the academy's Terms and Conditions and Student Conduct policies. * I agree to the academy's Terms and Conditions and Student Conduct policies. Thank You for submitting your Student Registration Form.Please email your GCSE Results to admin@platinumacademy.co.uk to complete your registration. If you have any questions, please do not hesitate to get in touch.
