Shine Performance Academy

The Causeway School

Larkspur Drive, Eastbourne BN23 8EJ 01323 465700

APPLICATION FORM

PUPILS DETAILS

Full Name: …………………………………………………………………….. Age: …………….……………………..

Address:…………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………

Current School: ………………………………………… Current school year: ………......

PARENT/CARER DETAILS

Name: …………………………………...... Relationship to the child: …………...………………..

Contact Number (1): …………………………………… Contact Number (2): ……………………………………

E-Mail Address: ………………………………………......

I would like to reserve a place for my child on the:

Winter Academy Spring Academy Summer Academy

Cost of Shine:

  • Shine runs every Monday 4.30-6.00pm and costs £7.50 per session.
  • For each academy we ask for the fees to be paid in two instalments in advance.
  • As a special introductory offer the first payment for the Winter Academy will include a free ‘Shine’ t-shirt which will be our uniform (usual cost £10)

Winter Academy

Dates: Monday 4Th November 2013 – Monday 10th February 2014 (13 weeks)

There will be an end of term performanceon Monday 10th February 2014.

Payment dates: Monday 4th November 2013 - £49.50

Monday 10th February 2014 - £49.00

Please make cheques payable to TheCauseway School and put in an envelope, with your application form, clearly marked ‘The Finance Office’ and post/hand into reception at The Causeway School

Places are limited and your place will only be secured when this form and payment has been received.

Spring Academy

Dates: Monday 24Th February 2014 – Monday 19th May 2014 (10 weeks)

There will be an end of term performance on Monday 19th May 2014.

Payment dates: Monday 24Th February - £35.25

Monday 31st March – £35.25

Please make cheques payable to TheCauseway School and put in an envelope, with your application form, clearly marked ‘The Finance Office’ and post/hand into reception at The Causeway School

Places are limited and your place will only be secured when this form and payment has been received.

Summer Academy

Dates: Monday 2nd June 2014 – Monday 14th July 2014 (7 weeks)

There will be an end of term performance on Monday 14th July 2014.

Payment dates: Monday 2nd June- £26.25

Monday 30th June – £26.25

Please make cheques payable to TheCauseway School and put in an envelope, with your application form, clearly marked ‘The Finance Office’ and post/hand into reception at The Causeway School

Places are limited and your place will only be secured when this form and payment has been received.

I enclosed cash / cheque for £……………… to cover the first instalment for the

Winter / Spring / Summer ShineAcademy (please delete so the appropriate Academy is shown)

Signed: ……………………………………………………………… Date: ……………………………………………

Parent Name : …………………………………………………………………………………………… (Please Print)

For further information or queries please contact Emily Carver ailto:r call 07961032405

For up to date information follow us on facebook @shine performance academy

For first time Shine Performers

Medical Details

Doctors Name: ………………………………………… Telephone Number: ………………………………………

Address: ………………………………………………………………......

…………………………………………………………………………………......

Does your child have any allergies? Yes No

If yes, please give details ……………………………………………………………………………………………….

Is your child taking any regular medication?’ Yes No If yes, please give details………………………………………………………………………………………………

Is there are any other medical issues that you would like us to know about?YesNo

If yes, please write a brief description here: …………………………………………………………………………………………………………………………………………………………………………………………….…………………………………………………………………

I agree, if necessary, for medical attention to be given if parents cannot be contacted.YesNo

I agree, to my child’s photo beingtaken during the activities they are taking part inYesNo

I agree, to my child’s photo being published in the paper YesNo

I agree, to my child’s photo being published on the school’s websiteYesNo

I agree, to my child’s photo being published on the Shine Facebook page YesNo

Please note: Children will not be allowed to leave without an adult collectingthem unless prior permission has been given for them to walk home alone.

Please indicate how your child will get home at the end of the sessions. (Prompt pick up is appreciated)

I will pick my child up at the end of the sessionsYesNo

I have arranged for ………………………………………………………...to pick my child up at the end of the day

My child has permission to walk home alone at the end of the dayYesNo