Shine Performance Academy APPLICATION FORM
Shine Performance Academy Summer School July – 3rd August 2013 The Causeway School Larkspur Drive, Eastbourne BN23 8EJ 01323 465706 29th
APPLICATION FORM PUPILS DETAILS Full Name: …………………………………………………………………….. Age: …………….…………………….. Address:……………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………… Current School: …………………………………………
Current school year: ……….......................................
Does the child above have any siblings who are also attending the summer school?
Yes
No
If yes, please list the names below: …………………………………………………………………….. …………………………………………………………………….. …………………………………………………………………….. What type of performance interests your child?.............................................................................................. PARENT/CARER DETAILS Name: …………………………………............................. Relationship to the child: …………...……………….. Contact Number (1): …………………………………… Contact Number (2): …………………………………… E-Mail Address: ………………………………………............................................................................................. I would like my child to attend on the following days (please tick): Monday
Tuesday
Wednesday
Thursday
Friday
All Week
All children will require a packed lunch, snacks and plenty of drinks (no fizzy or energy drinks allowed)
Prices for Shine Summer School – Monday 29th July to Friday 3rd August 2013 - 10am – 3pm £20.00 per day or £100 per week 10% Discount for siblings living at the same address 25% Early Bird Discount – Book and Pay by Friday 14th June 2013 Cheques payable to “The Causeway School” Please hand all completed application forms and payments in an envelope to your child’s school reception
Medical Details Doctors Name: ………………………………………… Telephone Number: ……………………………………… Address: ………………………………………………………………......................................................................... …………………………………………………………………………………................................................................ Does your child have any allergies?
Yes
No
If yes, please give details ………………………………………………………………………………………………. Is your child taking any regular medication?’
Yes
No
If yes, please give details……………………………………………………………………………………………… Is there are any other medical issues that you would like us to know about?
Yes
No
If yes, please write a brief description here: ……………………………………………………………………………………………………………………………… …………………………………………………………….………………………………………………………………… I agree, if necessary, for medical attention to be given if parents cannot be contacted.
Yes
No
I agree, to my child’s photo being taken during the activities they are taking part in
Yes
No
I agree, to my child’s photo being published in the paper and on the school’s website
Yes
No
Please note: Children will not be allowed to leave without an adult collecting them unless prior permission has been given for them to walk home alone. Please indicate how your child will get home at the end of the day. I will pick my child up at the end of the day
(Prompt pick up is appreciated)
Yes
No
I have arranged for ………………………………………………………...to pick my child up at the end of the day My child has permission to walk home alone at the end of the day
Yes
No
I enclosed cash / cheque for £……………… to cover the cost of the days my child will attend “Shine”.
Signed: ……………………………………………………………… Date: ……………………………………………
For further information or queries please contact Stephanie Blake: [email protected] or call 01323 465706 In September we are starting a Saturday School. Would you be interested in us sending you more information regarding this? YES NO
APPLICATION FORM PUPILS DETAILS Full Name: …………………………………………………………………….. Age: …………….…………………….. Address:……………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………… Current School: …………………………………………
Current school year: ……….......................................
Does the child above have any siblings who are also attending the summer school?
Yes
No
If yes, please list the names below: …………………………………………………………………….. …………………………………………………………………….. …………………………………………………………………….. What type of performance interests your child?.............................................................................................. PARENT/CARER DETAILS Name: …………………………………............................. Relationship to the child: …………...……………….. Contact Number (1): …………………………………… Contact Number (2): …………………………………… E-Mail Address: ………………………………………............................................................................................. I would like my child to attend on the following days (please tick): Monday
Tuesday
Wednesday
Thursday
Friday
All Week
All children will require a packed lunch, snacks and plenty of drinks (no fizzy or energy drinks allowed)
Prices for Shine Summer School – Monday 29th July to Friday 3rd August 2013 - 10am – 3pm £20.00 per day or £100 per week 10% Discount for siblings living at the same address 25% Early Bird Discount – Book and Pay by Friday 14th June 2013 Cheques payable to “The Causeway School” Please hand all completed application forms and payments in an envelope to your child’s school reception
Medical Details Doctors Name: ………………………………………… Telephone Number: ……………………………………… Address: ………………………………………………………………......................................................................... …………………………………………………………………………………................................................................ Does your child have any allergies?
Yes
No
If yes, please give details ………………………………………………………………………………………………. Is your child taking any regular medication?’
Yes
No
If yes, please give details……………………………………………………………………………………………… Is there are any other medical issues that you would like us to know about?
Yes
No
If yes, please write a brief description here: ……………………………………………………………………………………………………………………………… …………………………………………………………….………………………………………………………………… I agree, if necessary, for medical attention to be given if parents cannot be contacted.
Yes
No
I agree, to my child’s photo being taken during the activities they are taking part in
Yes
No
I agree, to my child’s photo being published in the paper and on the school’s website
Yes
No
Please note: Children will not be allowed to leave without an adult collecting them unless prior permission has been given for them to walk home alone. Please indicate how your child will get home at the end of the day. I will pick my child up at the end of the day
(Prompt pick up is appreciated)
Yes
No
I have arranged for ………………………………………………………...to pick my child up at the end of the day My child has permission to walk home alone at the end of the day
Yes
No
I enclosed cash / cheque for £……………… to cover the cost of the days my child will attend “Shine”.
Signed: ……………………………………………………………… Date: ……………………………………………
For further information or queries please contact Stephanie Blake: [email protected] or call 01323 465706 In September we are starting a Saturday School. Would you be interested in us sending you more information regarding this? YES NO
