Application Form: Tophill County Junior School
Please print this form out, fill it in and send it to:
Mr. D. J. Whistance
Kilderkin
The Old Malthouse
Nottington
Weymouth
Dorset DT3 4BH
Mr. Whistance,
Please enrol_________________________________
D.O.B.:___/___/___ Age:_____ Male/Female (Please delete)
Address:_________________________________
_________________________________________
_________________________________________
Post Code:____ ____ Tel.no:(_______) ____________
School:___________________________
Any relevant medical information (e.g. asthma):_______________________
Please delete one of the following:
- I enclose a cheque for �18 made payable to Mr. Whistance.
- I would like to pay weekly (�2 per session)
- I would like to pay weekly (�3 for both sessions)
Insurance cover is only �5 for the term.
Please indicate whether you have enclosed the insurance fee:_____
Signed:__________________________ (Parent/Guardian)
Signed:__________________________ (Young Person)
Please choose whichever meeting time is appropriate.
4:00-5:00p.m. / 5:00-6:00p.m.
Please circle B.A.G.A. level:
6(beginners) 5 4 3 2 1
Please note the meeting dates (all Thursdays):
| 3rd May |
10th May |
| 17th May |
24th May |
| HALF TERM |
7th June |
| 14th June |
21st June |
| NOT 28th June |
5th July |
| 12th July |
19th July |
If you have any questions please contact Mr. Whistance on (01305) 813237
or e-mail [email protected]
Questions/Comments? E-mail the organiser by clicking this button.
This website designed by Graham Lee