Boys Taster Open Workshop
(As part of Teacher CPD day)
Booking Form
Personal Details
First Name
Surname
DOB (DD/MM/YY)
Age on 1st September 2014
Address
Telephone No.
Email Address
Do you have any medical conditions, specific needs or access requirements that we should be aware of?
Please give details.
Emergency Contact Details
Name
Telephone No.
Home
Mobile
Relationship to applicant
Please return to Kirsten.jeavons@dancexchange.org.uk or DanceXchange Ltd. // Birmingham Hippodrome // Thorp Street //
Birmingham // B5 4TB. T. 0121 689 3170
Page 1 of 2
F. 0121 689 3170 // Company Limited by Guarantee // Company No. 2784677 // VAT No. 614 222 875. Registered Charity No.
1045364 // Registered in England & Wales
Page 2 of 2