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Emjay Summer School 2010 Please can you complete this form and send it to Liza Carter by 1st May 2010 with your deposit of ÂŁ15 per child to secure their places:

 Liza Carter, 65 Maybush Road, Southampton, SO16 9ET Name of main contact: Mobile number: Email address: Address:

Child 1: Name & age (as of August 1st): ______________________________________________________________________ Group (Please tick):

A

B

C

Dance experience:

Current dance school: Known medical conditions: Known allergies: Child 2: Name & age (as of August 1st): ______________________________________________________________________ Group (Please tick):

A

B

C

Dance experience:

Current dance school: Known medical conditions: Known allergies:

I enclose a cheque for ÂŁ______ to secure the above place(s) on the Emjay Summer School, Signed: _____________________________ Print: __________________________ Date: ________________

Application Form  

Form to be printed, filled out and sent to Liza Carter