Student Application Form - Grafton Academy

STUDENT APPLICATION

APPLICATION FORM

Preferred Course

2 WEEKS

3 WEEKS

1 MONTH

3 MONTHS

Workshop dates requested: From

Until

FIRST NAME*

LAST NAME*

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Name of your school

TY Co-ordinator:

Parent/Guardian Name

Relationship to you

Parent/Guardian Telephone Number:

Parent/Guardian Email:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

To confirm booking, you must have paid your deposit/full fee. Balance is payable before the course commences. I note that no fees are refundable or transferable and missed classes can not be made up. Payment may be made by Visa/cheque/cash/bank transfer.

I have read and agreed to our Terms and Conditions*

I agree to the terms and conditions

STUDENTS'S SIGNATURE*

DATE*

This field is for validation purposes and should be left unchanged.