Child Application

PUPIL

Forename*
Surname*
Prefered Name
(This is the name your child prefers to be known as)
Gender*	Male Female
Date of Birth*	--
Address*
Postcode*
Home Phone*
School Attended

PARENT/GUARDIAN

Title
Forename*
Surname*
Relationship*
Mobile Phone
Email*
(Your email address will only be used for communications with CentreStage and will not be passed on to 3rd parties)

If the parent/guardian's address is different to above please complete the details below.
Address
Postcode
Home Phone

ALTERNATIVE CONTACT

Title
Forename
Surname
Relationship
Phone

OTHER RELEVANT INFORMATION

Please specify which classes you would like to apply forPerforming Arts Ballet Tap Modern Jazz Contemporary Dance Commercial Dance
If your child has any medical conditions you feel we should know about please enter them below

Please give details of any performing arts experience your child may have, including examinations taken, school productions, etc.

How did you hear about us?*

By clicking send I confirm that the details shown above are correct to the best of my knowledge, I have read and agree to the Terms and Conditions and I wish to apply to CentreStage Theatre School MK.

*indicates required fields

PRIVACY INFORMATION

The information given on this form will be used for administration purposes only at CentreStage Theatre School MK. It will not be disclosed to any third parties.