Name: ________________________________________
.
Date of Birth: ___________________________________
Address (including post code): _____________________
Address (including post code): _____________________
_______________________________________________
_______________________________________________
Email address: ___________________________________
Home telephone: ________________________________
.
Mobile: _________________________________________
Residential or non-residential:_______________________
Residential or non-residential:_______________________
Suggested dorm companions: _______________________
.
________________________________________________
Special dietary requirements/medical conditions: _______
________________________________________________
Contact numbers for Parents/Guardians: ______________
.
_______________________________________________
INSTRUMENT
Instrument:_______________________________________
.
Most recent Exam/Date/Result:_______________________
Present Teacher: ___________________________________
When completed this form should be returned by 15th May 2012 (sooner if possible, to guarantee place) together with £80 deposit (see 'course details') made payable to Nikki Johnston;
Nikki Johnston
19, New Line Road,
Seaforde,
Downpatrick.
BT30 8PN.
Tel: 02844812022
*The balance is due on or BEFORE 12th June 2012
