Page 13 - Limitless Academy Brochure - V6 [324601]_Neat

APPLICATION FORM

Student Information

First Name: Surname: Likes to be known as:
Date of Birth: Age: Gender: M: F: Membership: Primary: Sibling:
If Sibling membership, please provide name of Primary student:

Medical conditions or other circumstances:

Academy Courses Uniform

Drama: Dance - Modern and Street: Singing: Shoe Size: Jazz Shoes: Tap Shoes:

TV and Film: Musical Theatre: Hoody: S: M: L: XL: XXL: Bag:
T-Shirt: S: M: L: XL: XXL: Cap:
Parent/Guardian Information

First Name: Surname: Home Telephone:
Mobile: Email: Relationship: Parent: Guardian:
Address:

County: Postcode:
Emergency Contact

Full Name: Relationship to student:

Home Telephone: Mobile:
Consent

Please only sign if you authorise your child to sign themselves in and out of the academy and to leave unaccompanied.
Signature: Print:
Terms & Conditions overleaf.