KBC summer experience Registration Form

KBC SUMMER EXPERIENCE

Thank you for registering your interest in the KBC Summer Experience.Date: Monday 21st-Friday 25th AugustTime: 10-4pm each day. (Family Showcase Friday 3:15pm)Location: Dance Jam Studios, 32 Villiers Street, Sunderland, SR1 1EJ. PRICING:£120* (Price included 5 day of workshops, free t-shirt and 2 tickets to family showcase per participant. *Sibling discount available)Please fill out this form to register a place in the KBC Summer Experience. Once completed we will send a confirmation email with details of registration and payment attached no later than 5 working days.
Participant Information
Participant Name

First NameLast Name
Birth Date

MonthDayYear
Parent/Guardian Information
E-mail
example@example.com
Name

First NameLast Name
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the participant prescribed an inhaler? If yes, please explain any instructions.
We agree to provide the following :

*A professional service.
*High quality workshops.
*Appropriately experienced staff with the necessary checks, qualifications and insurance.
*A safe and friendly environment for learning.

In return for this commitment to you, we ask that you agree to our terms and conditions before your book one of our programmes. Please contact us at: katiebrace@gmail.com if you have any questions before agreeing to the following terms and conditions.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

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Date
Signature

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KBC SUMMER EXPERIENCE

Participant Information