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

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

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

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

ANY MEDICAL CONDITIONS? ................................................................................

Please book MUSICAL THEATRE 5 day course @ £130       (ages 6+) - I enclose DEPOSIT £30 .... (please tick)

                                                         OR I enclose FULL BALANCE £130 .... (please tick).

Please book HIP HOP & STREET DANCE 3 day course @ £80 (ages 6+) - I enclose DEPOSIT £30 .... (please tick)

                                                          OR I enclose FULL BALANCE £80 .... (please tick).

Balance due by 26th June.

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.