Application Form for Adult Evening Classes 2012-13
Should you require assistance in completing this form please contact 01823 320800.
E Personal details (mandatory) E
Title: __________ Forename/s: _______________________________________ Surname: ______________________
Tel: (Home) _____________________________________________ Tel: (Mobile) _____________________________
Emergency contact name: ________________________________ Tel: _____________________________________
Date of Birth: _____/_____/________ Gender: M/F _________
Do you consider yourself to have a learning difficulty or disability? Yes No
If yes please provide further information or any special needs/aids/support required __________________________
Where did you hear about the course you are applying for?
Radio Word of mouth Mail shot Huish website Huish open day NAS
Newspaper If Yes which one Other Please state
E Your choice of programme (mandatory) E
Please circle your preferred option
Course Name £125.00 £125.00 £230.00 £125.00 £75.00
Introduction to Ancient Greece Part I Part II Both n/a n/a
Introduction to Creative Writing Part I Part II Both n/a n/a
Introduction to Digital Photography Part I Part II Both n/a n/a
Introduction to Psychology Part I Part II Both n/a n/a
History of the region n/a n/a n/a 10 week course n/a
The Thinkers’ Guide to the Good Life n/a n/a n/a 10 week course n/a
Beginners Guide to the internet n/a n/a n/a 6 week course
E Payment (mandatory) E
Cost of course (see above) ___________________________________________________________
Payments can be made by Credit/ Debit Card or PayPal via our Online Shop (http://shop.huish.ac.uk)
Or by cheque payable to Richard Huish College (write ‘Evening Class’ on the back). Please return cheques with the
completed application form.
Privacy statement (mandatory)
Data Protection: The information you have provided in this document will be treated as confidential and any personal information you have
supplied will not be passed on to a third party without your consent. Statistical information may be collected and analysed in accordance
with the Young People’s Learning Agency and the Skills Funding Agency requirements as well as examination boards. I have read the above
statement on the Huish Business School/YPLA/SFA’s use of data personal to me and I agree to such data about me being used as described.
I confirm all information provided is true, complete and accurate. I also agree to abide by the payment terms stated in the
Learner Signature: _____________________________________________ Date: _____________________________
DISCLAIMER: Richard Huish College hopes to run all of the advertised courses but for reasons beyond our control courses may
have to be cancelled or discontinued or course tutors changed. If this happens we will notify you. We may be able to offer
alternatives and or refunds.
Once you have completed this form, please return to:
Evening Classes, Richard Huish College, South Road,
Taunton, TA1 3DZ.