Let’s Pointe to Safety
Application Form

Course Fee £25.00 or $35.00 per session for 4 weeks.

Payment in advance of the commencement of the course upon acceptance by PayPal or bank transfer.

Please indicate preferred dates for course

Student Name

First Name

Last Name

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone

Education & Training

Information in support of the application

Please include any skills, experience and qualifications you have acquired that can support this application

Name of your teacher

Name of your studio/school

Studio Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Studio Phone

Studio Email

I confirm that, to the best of my knowledge, the information I have provided on this form is correct and I accept that providing deliberately false information could result in student's dismissal.

If a minor, Name of Parent or Guardian.

Date

Please have you teacher sign below to signify their approval for you to attend the Let's Pointe to Safety! Course.
By our signatures hereon, we accept thet Sue Hewgill Peterson accepts no responsibility for injury or illness either in the studio or home environment whilst taking the course. Please be aware that suitable flooring is vital for pointe work and a ballet barre if helpful, but a chair back can be used if it is a suitable height.

Date

Thank you! Please keep an eye on your email inbox for the next steps. Payment information for the course can be found below.

Payment Information
£25.00 or $35.00 per week per student, payable in advance.
Payable via Paypal to suehewgillpeterson101@gmail.com or email suehewgillpeterson101@gmail.com for bank transfer details.

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Let’s Pointe to SafetyApplication Form

Let’s Pointe to Safety
Application Form