TO BE COMPLETED BY PARENTS/GUARDIANS - ONE FORM PER CHILD PLEASE
NAME OF PARENT/GUARDIAN................................................................................................
ADDRESS: .........................................................................................................................
.........................................................................................................................................
EMAIL ADDRESS: ...............................................................................................................
TEL. NO: ...........................................................................................................................
EMERGENCY TEL. NOS:.......................................................................................................
NAME OF CHILD:..................................................................................................................
DATE OF BIRTH:..................................................................................................................
INTERESTS/HOBBIES:..........................................................................................................
HEALTH PROBLEMS (if any):..................................................................................................
I found out about the course from:........................................................................................
I would like to reserve a place on the 2012 Drama Summer School:
Monday 23rd July - Friday 27th July, 10.30am-3.30pm, at St Francis de Sales Church hall
I enclose a cheque for the deposit of £15.00, made payable to J.K. KIRKE.*
I have read and accept the “conditions of inclusion on the course”.
SIGNED: ...................................
DATE:.......................................
Please print, complete & return this form together with your deposit to:
J.K.Kirke
actfirst
12 Bye Ways,
Twickenham
Middx TW2 5JN
*In the unlikely event of a cancellation you will be refunded in full.