Activities for Gifted & Talented Learners

at Lancaster University

GROUP BOOKING FORM

The Deadline for Bookings

is 10 days prior to the event

Title of Activity
Date of Activity
School Name (Please give full name)
School Address
Postcode
School Telephone Number / Local Authority
Email Address
Accompanying Teacher’s Last Name / Teacher’s First Name


PAYMENT DETAILS

The fee for this activity is £20 per learner. However learners who are eligible for Free School Meals are entitled to a free place.

Please tick the box to state your preferred method of payment:

c Enclosed cheque for £ made payable to Lancaster University.

(Insert total amount payable for fee-paying learners.)

c Credit card payment

Please charge £ to c Mastercard c Switch c Visa (please tick)

Card Number:

Three digit security number (on back of card):

Valid from Date: Expiry Date:

Signature of Card Holder:

Date:

c Invoice to school or LA for £

Name of organisation to be invoiced:

Address where invoice should be sent (if different from school details on front page):

Postcode:

For all Payment Methods

Name of person to contact in case of payment query:

Telephone number:

TO BE COMPLETED BY HEADTEACHER OR DEPUTY

I confirm that:

·  the information given on this booking form is accurate

·  that all learners for whom details have been given have been identified as gifted or talented

·  that the necessary permissions for the learners’ attendance have been obtained from parents or carers

Signed Print Name

Position in School

THIS BOOKING FORM SHOULD BE SENT NO LATER THAN 7 DAYS PRIOR TO THE ACTIVITY TO:

Claire Boak, Department of Continuing Education,

Lancaster University, LANCASTER LA1 4YT

Tel: 01524 93546

Fax: 01524 592448

E-mail:

LEARNER DETAILS

Last Name / First Name / Age / Year / Gender / Eligible for Free School Meals? YES/NO / Permission for photographs or video to be taken obtained
YES/NO / Special Needs

Fees Payable

Number of places booked: @ £20 = £ Number of places for learners eligible for FSM

Notes

1  All personal data will be held in compliance with the Data Protection Act 1998 and Lancaster University’s Data Protection Policy.

2  The Excellence Hub of the NW is required to obtain information regarding eligibility for Free School Meals as part of the funding agreement with the DCSF and YG&T.