Registration Form

Course Dates: Sunday 19th - Saturday 25th August 2012
Performance: Saturday 25th August, 8.00pm

Please fill in all fields before pressing the 'send' button.

Full name:

Date of birth:

Gender: Male Female

Address:

Town:

County:

Postcode:

Home telephone

Mobile

E-mail

T-Shirt size:

(please tick one option below)

9/10 Years
11/12 Years
Adult S

Adult M
Adult L
Adult XL

Do you have any disability or medical conditions which we would need to cater for? Yes No

If yes, what are they?

Which aspects of theatre are you most interested in?

(please tick one or more options below)

Drama
Dance
Music
Design/Technical

Please ask a parent/guardian to complete the following:
I give consent for
to attend the Blast! 2012 course.

Full name:

Relationship:

I am paying:

(please tick one option below)

By cheque - Full payment of £120
By cheque - £50 non-returnable deposit and will pay the remainder by July 1st 2011
Online - Full payment of £120

Data Protection Act: Information being recorded here is held under the Data Protection Act 1998 and will not be passed on to anyone else.