Course Registration Form

New Student Enrolment Form
Student Name *

First Name Last Name
Student Name / Child 2 (if applicable)

First Name Last Name
Parent / carer contact E-mail: *
example@example.com
Photo (Optional)
Birth Date - Student 1

Month Day Year
Birth Date - Student 2 (if applicable)

Month Day Year
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mobile Number

Phone Number
Select a course
Previous experience?:(LAMDA/RADA/ARTS AWARD)

Yes No
If yes, please add details:
I consent to being contacted by Chalkpit Theatre Arts by phone

Yes No
I consent to being contacted by Chalkpit Theatre Arts by e-mail

Yes No
I consent to lessons being photographed / filmed for teaching / promotional materials / online safety purposes only

Yes No
I understand that 6 weeks notice must be given when ceasing tuition, or the fee paid in lieu of classes for this period

Yes No
I understand that LAMDA examination fees are in addition to classes (*please ask for details. Exams will take place 1-2 times per year depending on age, progression and experience)

Yes No

Payment amount:

GBP Please leave blank if you are paying by bank transfer (07-02-46 19575848) or key in the amount you would like to pay. See website for payment amounts or contact info@chalkpittheatre.com

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Additional comments / anything that would be helpful for us to know about your child?
Should be Empty:

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New Student Enrolment Form