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STUDENT DETAILS PARENT OR GUARDIAN DETAILS ALTERNATIVE CONTACT IF

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STUDENT DETAILS PARENT OR GUARDIAN DETAILS ALTERNATIVE CONTACT IF

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									Please complete in BLOCK CAPITALS


STUDENT DETAILS

Full Name:

Age:

Date of Birth:

Male              Female




PARENT OR GUARDIAN DETAILS

Full Name:

Title:

Telephone

Home:                                Mobile:

Email:

Relationship to Student:


ALTERNATIVE CONTACT IF NECESSARY (Friend or Relative)

Full Name:

Telephone

Home:                                Mobile:

Relationship to Student:
EXPERIENCE (If Any)

Please use this section to inform us of classes attended or grades achieved in Dance,
Drama and Singing.




IMPORTANT ADDITIONAL INFORMATION

Please use this section to inform us of any medical information you may think we need
to know. (ie. Allergies, Asthma, epilepsy etc)




DECLARATION (To be signed by Parent/Legal Guardian)

I declare that the information given in this above application form is correct. Any
changes relating to contact details or health issues will be
made available to ‘Performance Central’ when necessary.

I enclose a cheque payable to ‘Performance Central’ in respect to the Deposit.
I understand that if for any reason a place is unavailable, my cheque will be returned
forthwith.

I understand that the information above will be used by ‘Performance Central’, for the
purposes of administration, research and the provision of teaching services, also
Performance Central’s statutory obligations under legislation relating to children.

Performance Central will not disclose the information above to any third parties for
marketing purposes.

Signed: ……………………………………………………………….………………

Date: ………. / ………. / ……….

								
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