Book a Two Week Trial by completing the form below Full Name of Parent/Guardian * Email * Emergency Contact Number * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Full Name of Child * Child's Gender * Male Female Child's Date of Birth (dd/mm/yyyy) * Second Child's Details (if applicable) Child's Gender Male Female Child's Date of Birth (dd/mm/yyyy) * What would your child/ren like to study? * Piano Singing / Musical Theatre Acting (LAMDA exams) Music Theory Are there any medical issues or additional information that we should be aware of? * How did you hear about us? * Word of Mouth Flyer from School Flyer from Local Shop/Amenity Facebook Attended Previously Internet Search The Best of Walsall West Midlands Police/Fire Sports and Social Club Theatre/Show Programme Other I agree to the Terms of Service. * Yes Thank you! We will be in touch will you soon with all the details regarding your child’s Two Week Trial.David and Rachel Hardway(Co-Principal’s of Breakout Performing Arts)
