CHILD'S NAME: ............................................................................ AGE: ........

EMERGENCY CONTACT TEL: .................................................................................

EMAIL: .................................................................................................

ADDRESS: ...............................................................................................

ANY ALLERGIES or MEDICAL CONDITIONS? .....................................................................

Please book DISNEY CHARACTER 3 day course @ £36      (ages 4-9) - I enclose £36 .... (please tick)

Please book CHEERLEADING & BATON 3 day course @ £36  (ages 4-9) - I enclose £36 .... (please tick)

Booking for both courses (ages 4 plus) £78 inc. lunch cover     - I enclose £78 .... (please tick)

Cheques payable to Beverly Marks Stage School. Credit card bookings 01708 438883.

PLEASE PRINT THIS FORM, COMPLETE IT AND HAND IT IN WITH YOUR PAYMENT.