Prima Application Form
Please print this page, complete form and return to:

Julie Hutchings
Prima Stage School
79 Heron Road
Larkfield
AYLESFORD
Kent ME20 6JL

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Classes applying for (please tick dot):

• Ballet • Tap • Modern Jazz Dance • Theatrecraft • Contemporary Dance • General Dance

• Drama • Singing • Musical Theatre • Streetdance • Cheerleading • Gymnastic Dance

Preferred location • Larkfield Leisure Centre • Kings Hill • (7 and under Ballet and • Musical Theatre only)

Name of Pupil
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Address
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Post Code
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Telephone No
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Mobile No
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E-mail
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Date of Birth (if under 18)
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Previous Experience
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Examinations Taken
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Medical Problems we should be aware of
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Signature
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Date
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Teaching dance may involve some physical contact between teacher
and pupil for posture guidance.
If you have any objection please tick here •