Join MPA

mark proctor academy registration and consent form

If you would like to join Mark Proctor Academy please fill in the form below and we will contact you with everything you need to get started.

* FIELDS ARE REQUIRED INFORMATION

THIS FORM IS TO BE COMPLETED BY THE LEGAL CARER OF THE CHILD BEING ENROLLED TO MARK PROCTOR ACADEMY. LEGAL CARERS ARE RESPONSIBLE FOR INFORMING MARK PROCTOR ACADEMY OF ANY CHANGES AS THEY OCCUR.

Mark Proctor Academy respects your privacy

Any personal information you provide to us including and similar to your name, address, telephone number and e-mail address will not be released, sold, or rented to any entities or individuals outside of Mark Proctor Academy.

PLEASE SELECT

Parent Name

First Name

Last Name

Name of child *

First Name

Last Name

Date of birth (DD/MM/YYYY)

Current School Year

Current team

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact number

Child health information

Does your child currently have any health needs? e.g. diabetes, asthma, epilepsy, allergies. If so, please give full details below including medication taken.

Social media consent

At times, Mark Proctor Academy may wish to take photos or videos of group sessions or individuals involved in Mark Proctor Academy sessions. These then may be used and shared via social media.

I am happy for my child to be part of MPA's social media

I do not wish for my child to be part of MPA's social media

Contact

Please tick if you are happy for Mark Proctor Academy to contact you via:

Phone

Social media

I understand to attend MPA, the cost is £384 per year which can be paid over 12 months by standing order, on the 1st of each month. Payments to be made one month in advance on the date of joining MPA

Yes

I understand I can leave MPA at any time but must let MPA know at my earliest convenience

Yes