Summer Workshop Application Form

If you would like to book a place, please fill out the form below and post to Victoria Bremner, InsideOut:Summer Dance 2006, 17 Osprey Drive, Uckfield, East Sussex, TN22 5PF. Name of Student:………………………………………………………………………………………… Date of Birth:………………………………………………………………….…………………………… Name of Parent/Guardian:………………………………………………………………………………. Contact Telephone Number:……………………………………………………………………………. Mobile Telephone Number:……………………………………………………………………………… Address:…………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… Please state below any medical condition the pupil has which the teacher should be aware of: ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… Please circle the day or days you would like to do: Thursday 3rd August Only (£15) Friday 4th August Only (£15) Thursday 3rd August and Friday 4th August (£24) I enclose a cheque made payable to Victoria Bremner for £15/£24 (delete as appropriate) for the Summer Dance Classes. Parent/Guardian Signature…………………………………………………………………………………….. Date…………………………………………………………………………………...………………..…………….. CLOSING DATE 31st JULY 2006 You will be notified by InSiDeOuT: Dance when your booking has been confirmed. Any queries please telephone: 07841 922 631 or email [email protected] Postal address for bookings at the top of this page Class Venue (Please note this address is different to the booking address). High Hurstwood Village Hall, High Hurstwood, Uckfield, East Sussex, TN22 4AD.