EmailMe Form - Summer School Application 2020

Name of Parent / Guardian *

Prefix First Last

Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Telephone Number *

Email Address *

Pupil's Name *

First Last

Age on 1st August 2020
(min 5ys - max 14yrs) *

Sibling 1
(if required)

First Last

Age on 1st August 2020
(min 5ys - max 14yrs)

Sibling 2
(if required)

First Last

Age on 1st August 2020
(min 5ys - max 14yrs)

Tick here if you are not a Manor School pupil

Non Manor School Pupil

Do you attend another dance school?

Yes

No

If YES, please state dance school

Medical Information / Allergies

*Please provide FULL detailed information*

Please give the names of two people we can contact in the event of illness or emergency

Emergency Contact (1) *

Prefix First Last

Daytime Phone Number *

Emergency Contact (2) *

Prefix First Last

Daytime Phone Number *

Parental Consent

I give permission for my son/daughter to participate in The Manor School of Ballet Summer School.

I understand that photos or video footage may be taken from time to time for marketing and advertising purposes.

I give permission for my child to be taken on local excursions under the supervision of Manor School staff.

In an emergency I give my permission for the medical authorities to administer their skills where necessary until such time that I can be contacted.

I understand that payment is required in full to secure my child’s place and I understand that in the event of illness or failure to participate the Manor School of Ballet will only refund 50% of the total cost. Please note - this only applies to non-participation of the entire week. Day illness or non-attendance will not be refunded in any part.

In the unlikely event that The Manor School of Ballet cancels Summer School, a full refund will be made by the Manor school of Ballet.

Electronic Signature *

Parent / Guardian

By ticking the above box, you are agreeing to the Parental Consent section above

Name *

First Last

Date *

DD / MM / YYYY

upon clicking SUBMIT your application will be sent & we will contact you.