Iris Tomlinson Fund
Application for concession form:
Please complete and return this form to
to apply for support from the Iris Tomlinson Fund.
Applications should be submitted on an event/ term basis.
Please complete the form fully to ensure your application is considered.
Deadline to return your completed form: The First Saturday of term time.
Or Five working days before the start of holiday projects.
Please note you will need to make your booking by phone or in person and put a deposit down to secure the place.
Participant Name: Click here to enter text.
Name of Class/ course you are applying for ITF support for :Click here to enter text.
Cost for class: Click here to enter text.
Age of participant: Click here to enter text. School Year: Click here to enter text.
Parent / Guardian details
Name of Parent / Guardian: Click here to enter text.
Email address: Click here to enter text.
Where do you live?
London Borough of Camden ☐
Other London Borough (please specify)Click here to enter text.
Outside London (please specify)Click here to enter text.
Address: Click here to enter text. Post code: Click here to enter text.
How long has your child regularly attended dance classes or projects at The Place?
0year ☐
1-2 years☐
2-3 years☐
3-4 years☐
4-5 years☐
5+ years☐
Does your child receive Pupil Premium? Yes ☐ No ☐ Unknown☐
If in school year 3 or above is your child eligible for free school dinners? (This does not include pack lunch but if you are entitled to receive free School meals, as a way of means testing not a dietary choice)Yes ☐ No ☐
What is your average family annual earned income? (Do not include benefits)
£0 per annum☐
Less than £20,000 per annum☐
£20,001-25,000 per annum☐
£25,001-£30,000 per annum☐
£30,001-£40,000 per annum ☐
£40,001-£50,000 per annum☐
£50,000+ per annum ☐
Do you receive any benefits Yes ☐ No ☐
(If yes please specify) It is important to complete this section fully.
Disability Benefits☐Widowed Parent allowance☐
Working Tax Credit☐Child Tax Credit☐
Housing Benefit☐Job Seekers Allowance☐
Care/Money to learn☐Carer Benefits☐
Employment and support allowance ☐
Other ☐please specify Click here to enter text.
How many dependents under 18years do you have?Click here to enter text.
Does your child attend any other dance activities/schools e.g. School Dance Club/ ballet classes?
Yes ☐ No ☐(If yes please specify)Click here to enter text.
If yes, do they receive support for these activities? Yes ☐ No ☐
PLEASE NOTE: IF THE SECTION BELOW IS NOT COMPLETED WE ARE UNABLE TO CONSIDER YOUR APPLICATION. Student applicant: Please write a brief outline of why you want to join this class/company and how it will benefit you, you may continue on a separate sheet if necessary.
This section must be completed by the student if over 7 years old; support can be given to younger children.
Click here to enter text.
Is your child’s place dependent upon support from the Iris Tomlinson Fund?
Yes ☐ No ☐
Signature of Parent / Guardian: Click here to enter text.
Date:Click here to enter text.