BBO Scholars Weekend Saturday 26th and Sunday 27th October 2013 Elmhurst School for Dance, Birmingham SCHOLAR BOOKING FORM – BOOKING DEADLINE: MONDAY 21ST OCTOBER 2013 ALL Scholars are expected to attend the weekend as part of their Scholarship. THE ATTACHED “PARENTAL MEDICAL CONSENT FORM” MUST BE RETURNED WITH THIS BOOKING FORM Name: Date of Birth: Address: Male / Female: Age (at 26th October 2013): Postcode: Telephone: Email: Further information will be sent by email once your booking form has been processed. If you have not received an email within 14 days of applying please contact BBO Headquarters at selena@bbo.org.uk. PLEASE APPROPRIATE BOX £165 Residential Student – Course fee includes: All meals refreshments, accommodation, coach travel & classes Non Residential Student – Course fee includes: All classes, lunch & refreshments £110 PLEASE CIRCLE THE SCHOLARSHIP SCHEME YOU ATTEND Junior Ballet South Junior Scottish Junior Ballet North Jazz North Senior Scottish Senior Ballet Jazz South Male Scholars Dietary Requirements: _________________________________________________________________________ Room Sharing: For this event, we will be using triple bedrooms. Please note that room sharing requests cannot be guaranteed – although we usually experience no problems in accommodating all wishes. 1. ___________________________________________ 2. ___________________________________________ Payments to the BBO You can make a payment to the BBO in the following ways: 1. By Cheque (payable to: BBO) 2. Credit/debit card Amount To Pay: £_______________ Name on card: _______________________________________ Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiry Date: ____/____ Security Number (the last 3 digits on the back of the card): __ __ __ 3. By BACS transfer directly into our bank account. If you chose to make payment this way then please ensure you send an email to selena@bbo.org.uk with the following details: Your Name Your daughter/son’s name Date the payment was made Payment amount Please also ensure that this booking form is emailed to selena@bbo.org.uk or posted to the address at the bottom of the page. Account Details Bank: Account Name: Sort Code: Account Number: Natwest Bank, 149 Church Road, Barnes, London SW13 9HS British Ballet Organization 60-01-39 35591668 Refund Policy If a student withdraws from the course due to illness/injury or personal mitigating circumstances (e.g. serious injury or bereavement) then the following refund policy will apply. If withdrawal is made up to Monday 7th October 2013; The full course fee will be refunded less a £25 administration fee. If withdrawal is made after Monday 7th October 2013; 50% of the course fee will be refunded less a £25 administration fee. All refund requests must be sent in writing and received no later than Monday 4th November 2013. Please include all documentary evidence (such as a medical certificate) when applying for a refund. Please return completed form to: Scholars Weekend, BBO, 39 Lonsdale Road, Barnes, London SW13 9JP or selena@bbo.org.uk Tel: 0208 748 1241 British Ballet Organization Scholars Weekend, October 2013 Parental consent form I give permission for my child to take part in BBO’s Scholars Weekend 2013 at Elmhurst School for Dance, Birmingham. I acknowledge that the British Ballet Organization Staff & Housemothers will take all reasonable steps throughout the course to prevent her / him from any accidents or other harm. I understand that in the event of an accident or other emergency every effort will be made to contact me. If staff are unable to make contact, I agree to the person in charge of the group giving consent on my behalf for any urgent medical treatment which is deemed necessary by a qualified medical practitioner (including transportation to hospital, blood transfusion and a general anaesthetic) and accept that such a practitioner will need to be informed of any condition / medication previously disclosed to the BBO. I understand that photographs may be taken at this event for publicity purposes. Please provide details of any relevant illnesses/injuries and any regular medication: Next of Kin: ________________________________ Relationship __________________ Emergency contact telephone numbers: _______________________________________ _______________________________________ Signed: ______________________________________________ Print Name: ___________________________________________ Parent / Guardian of: ____________________________________ Date: ___ / ___ / 2013