CENTRE STAGE DANCE AND DRAMA

 

REGISTRATION  FORM  - one per student

 

 

 

SURNAME                  …………………………………………………………..

 

FIRST/CHRISTIAN NAME(S)       ………………………………………...

 

Date of Birth     …………………………………………………………..

 

ADDRESS         …………………………………………………………..

                        …………………………………………………………..

                        …………………………  POSTCODE ..……………....

 

CONTACT Tel: [Home] …….………………    [Work] ……...……………..….

MOBILE:   [Mother] ………………………..       [Father] .…………………...…

                    [Nanny] …………………………

E-MAIL ADDRESS ………………………………………………………………..

 

Please complete below: 

The COURSE: ( Ballet; Modern;Tap; Hip-Hop/Street Jazz; Drama etc ) DAY: TIME: VENUE: & DATE: student will be attending –

e.g. Ballet, Mondays, 3:00pm, Scout Hut, Oxshott, starting May 12^th 2007

 

COURSE:         …………………………………………………………..

DAY:                        …………………………………………………………..

TIME:               …………………………………………………………..

VENUE:            …………………………………………………………..

DATE starting: …………………………………………………………..

 

Are there any Medical, Educational or Family circumstances we should be aware of?

If so,  please give details below: [This information will remain confidential]

 

………………………………………………………………………………………………………………………

 

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SIGNED: [Parent/Guardian]  ……..………………………………………………

 

Print Name …………………..……..………………………………………………

 

 

Please return to class teacher or to Suki Turner, CSDD, 5 Downside Court, Downs Lane, Leatherhead, KT22 8JW