Application Form for New Pupils

If you would like to apply for a place at the school, please print out this page, complete the necessary sections and either bring it to the first lesson or send it to:

The Samara Ballet School
35 High Street
Burwell
Cambridgeshire
CB25 0HD

Introduction

Preferred Venue/Day: .....................................................................................

Contact Details 

Pupil Name: ................................................. Date of Birth: ..........................

Address: Mr/Mrs/Miss ....................................................................................

..............................................................................................................................

..............................................................................................................................

Post Code: ........................................................................................................

Telephone Number: .......................................................................................

Mobile Number: ...............................................................................................

E-mail address: ................................................................................................

Which classes are you interested in? 

Ballet: ..................................  Grade: .................................................

Tap: ......................................  Grade: .................................................

Melody Bear: ...................... Grade: .................................................

Does your child have any special needs that we should be aware of? If 'yes', please give brief details: ..........................................................

...............................................................................................................................

...............................................................................................................................

............................................................................................................................... 

From time to time, photos of pupils are used on the school website (Achievement Awards winners, competition winners, exam results, show photos etc.)  If you are happy for photos of your child to be used then please sign your acceptance below:

I confirm that I give my permission for photos of ……………………………(name of child) to used on the Samara Ballet School website. 

Signed ……………………………………  Date: ……………………..…….