Enrolment Form

Title

Member of Staff ?

Previous Student ?

First Name

Surname

Address

Post Code

Home Telephone Number

Mobile Number

Email Address

Date Of Birth

Next of Kin details

Name

Relationship

Telephone

Do you have a disability or learning difficulty?

Do you have any health concerns, allergies, or are you receiving any medication?

Title

Duration

Date of Commencement

Price

A 50% deposit is required to secure your place. The deposit is non-refundable.

All cancellations must be made in writing, no less than 14 working days prior to your original start date.

The final balance is to be made, in full before 10 working days of the commencement of your original start date.

Please make cheques payable to: K.Allegretti.

I confirm I have read & understand the terms & conditions of business as set out on this Internet site/form & I agree to be bound by this.