Boys Ballet 5 Week Pilot Course

Boys Ballet – 5 Week Pilot Course

2016Application Form

Friday 20 May— Friday 24 June

(No lesson on Friday 3 June)

Surname: First Names:
Address:
Postcode:
Telephone No.(incl. code): Email Address:
Date of Birth: / Age:
Nationality:
Contact name in case of emergency:
Relationship to child:
Telephone no. (incl. code):
MAILING LIST
Please include / do not include (delete as appropriate) my email on your mailing list to receive notification of future Widening Participation & Access events.
Email:
Central School of Ballet may take photographs and/or film footage of this event for publicity purposes. To comply with the Data Protection Act 1998 we need your permission before any images of your child are taken.
I give / do not give (please delete accordingly) permission for my son to be photographed and/or filmed during this event, and for the resulting images to be used by Central School of Ballet.
Signed: ______(parent/guardian)
Date: ______

TRAINING TO DATE

Have you studied: / YES / No / Most recent examination taken. Please state examining board, level, date taken and result
Classical Ballet
Contemporary Dance
Other (Please state)
About you: / YES / NO / If yes, please specify
Do you have any injuries?
Do you have any health conditions or allergies we should be aware of?
Have you previously attended any dance courses?

Name and addresses of dance schools, teachers and date attended starting with your current teacher (please continue on an additional sheet if necessary):

Name of Dance Teacher / Address of Dance School / Dates Attended / Hours per week

Does the participant attend a state school? YES/NO (If yes, please give the name, address and postcode below)

Name: Address:
Postcode:

Boys Ballet Bursary

Thanks to funding from the CDD we are delighted to be able to offer a limited number of bursaries for the Boys Ballet pilot.

The bursaries are awarded on financial need, by income assessment.The bursary selection process will be administered at the discretion of Central School of Ballet.

In order to be considered for abursary your household income must be £25,000 or under.

-I would like to be considered for a bursary: YES/NO

In the space provided, please write a brief description of no more than 200 words as to how you would benefit from a bursary.

(Up to 200 words)

Please ensure all information is completed in this applciation form, including the Equality and Diversity form on page 5, in support of your considered application for a bursary.

If you are applying for consideration for a bursary, upfront payment will not be required.

I confirm that all information given to support the application for the Boys Ballet bursary is correct.
Signed: ______(parent/guardian)
Date: ______

Bursary awards cover the course fee only.

Boys Ballet – 5 Week Pilot Course

Application Form

PAYMENT

Cheques should be made payable to ‘Central School of Ballet'. Please print the participant’s name on the back of the cheque. Please note that an administrative charge of £25 will be levied against any cheques returned by the bank.

Alternatively you can pay online through our website

You can also call the Widening Participation & Access Department during office hours

(9.30am-5.00pm) and pay by credit/debit card over the telephone.

How did you pay for this course?

If you are applying for consideration for a bursary, upfront payment will not be required.

Cheque Enclosed  / Credit Card 
Date......

Completed application forms should be sent to:

Widening Participation & Access

Central School of Ballet

10 Herbal Hill

Clerkenwell Road

London

EC1R 5EG

Please enclose the following with your completed application form:

- Equality & Diversity Form

DECLARATION

This is to certify that to the best my knowledge the information provided in this document is accurate at the time of writing. I accept that any amendment to the information provided after acceptance and acknowledgement of this application could result in the loss of a course place and deposit. I have also read and understand the Refund Policy detailed on page 6 of the application form.

Signed (Parent/Guardian): / Print Name: / Date:

Please note that there are restricted numbers on the course

Equality and Diversity Information Form

Central School of Ballet welcomes applications/participants from all sections of the community regardless of ethnicity, gender, religion or disability. The information you give in this section is used for statistical and monitoringprocesses only and to ensure that we deliver an outreach programme for all sectors of the community.

Age of Participant: ......

How old were you when you started ballet? ......

Did either of the participant’s parents/guardians attend higher education?......

Gender:Male Female

Please tick the box or boxes which best describe your ethnic or cultural background:

White British / I do not wish to give this information
White Irish / Other Asian background
Black or Black British –Caribbean / Mixed – White and Black Caribbean
Black or Black British – African / Mixed – White and BlackAfrican
Other Black background / Mixed – White and Asian
Asian or Asian British – Indian / Other Mixed background
Asian or Asian British – Pakistani / Arab
Asian or Asian British – Bangladeshi / Other Ethnic background
Chinese /
Which of the following statements about disability is most appropriate to you? Please tick the appropriate box(es).
No known disability / Long-standing illness or health condition, e.g. epilepsy
Blind / serious visual impairment / Two or more impairments and/or medical conditions
Deaf / serious hearing impairment / Social/communication impairment, e.g. Autistic Spectrum
Physical impairment or mobility issues / A specific learning difficulty e.g. dyslexia
Personal care support / A disability, impairment or medical condition not listed above
Mental health condition / I do not wish to give this information

Household Income - Please indicate the income bracket which your household falls into:

Less than £25,000  Less than £42,620  Less than £60,000  Over £60,000 

For further information about Central School of Ballet please go to

Boys Ballet – 5 Week Pilot 2016

Information Sheet

NOTE: Please read this document carefully and retain for your reference.

DRESS

Those who are attending the Beginners Ballet classes should wear something comfortable and suitable to dance in. Those who are taking the Advanced Ballet class should wear your usual ballet uniform.

TIMETABLE

Students will be assigned a group prior to the start of the course, you must have been taking regular Ballet classes for over 2 years to be considered for the advanced classes. You will be notified of your group by email confirmation. Groups are chosen at our discretion and our decision is final.

11-16 yrs (Beginners) 5.30pm-6.45pm

12-16 yrs (Advanced) 7.00pm-8.30pm

OUR LOCATION

10 Herbal Hill

London

EC1R 5EG

Central School of Ballet is located near Farringdon tube and Overground station. Chancery Lane tube is also within ten minute walk.

CentralSchool of Ballet is proud to be a partner school of the Prix de Lausanne

and an affiliate of the Conservatoire for Dance and Drama.