This form is only for members of the Basingstoke Tappers dance company to request an account to gain access to the private part of the website. 

Please print this page and complete the details.  Once completed, please supply to Tracey Kinchenton.

Name:__________________________________________________________

Email Address:____________________________________________________

(please write in block capitals)

Parental/Guardian's

Signature of Consent*: ______________________________________________

Parent/Guardian's

Name:___________________________________________________________

 I here by acknowledge that I shall abide by the rules of the website...

Signed:__________________________________________________________

* For Tappers under the age of 16, parental consent is required.

 For Tracey Kinchenton to complete:

Tick box to indicate chat room allocation.