Child's Name:
Age:
Emergency Contact Number On The Day:
E-mail:
Any Medical Conditions/Allergies:
I would like to book my child on the following workshop (please tick)
q Friday 20th August 2010 @ Bure Park Primary School, Bicester
q Wednesday 25th August 2010 @ Racquets Fitness Centre, Thame
q Thursday 26th August 2010 @ Downley Methodist Church
COST: £20.00 per child (There is a 10% discount for siblings)
Please make cheques payable to: Louise Austin School of Dance Ltd
I enclose cheque/cash £
Signed Parent/Guardian:
Please hand the form with payment to your teacher or post to:
Louise Austin School of Dance
8 Clarendon Drive
Thame
Oxon
OX9 3XP
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