Certificate 111 Dance - Charles Campbell College€¦ · Film/TV Hrs/wk Community Service Hrs/wk...
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Transcript of Certificate 111 Dance - Charles Campbell College€¦ · Film/TV Hrs/wk Community Service Hrs/wk...
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Certificate 111 Dance
STUDENT ORDER FORM Please complete form and make payment to FRONT OFFICE
Students will be required to order the ladies or Men’s T shirt: Black T shirt with White
writing
*******Required for Certificate 111 Dance/Arts Performances and Exhibitions
Name of Student:
Male Female
Home group:
Name of teacher:
Class:
LADIES- T shirt
Size 8
Size 10
Size 12
Size 14
Size 16
Size 18
Size 20
Size 22
Size 24
Total number
Total cost $20 Inc. GST Per T-Shirt
MENS- T shirt
Size S
Size M
Size L
Size XL
Size 2XL
Size 3XL
Size 5XL
Total number
Total cost $20 Inc. GST Per T-Shirt
TOTAL quantity
Office use only (on completion of payment)
TOTAL Cost
LADIES AND MENS Sizes
LADIES 6 8 10 12 14 16 18 20 22 24
HALF CHEST (CM) 44 46 48 50 52.5 55 57.5 60 66.5 71
MENS
S
M
L
XL
2XL
3XL
5XL
HALF CHEST (CM) 54 56 58 62 66 71 79
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PLEASE COMPLETE ALL SECTIONS OF THE APPLICATION FORM.
STUDENT DETAILS
Date:
Date_______ Family Name
Preferred Name
Given Name
Gender
Student Photograph
Female Male
Date of Birth Secondary School
In 2019, I am in Year 9 / 10 / 11/12
Are you of Aboriginal or Torres Strait Islander descent? Yes No
Family Name if different:
CONTACT DETAILS Parent / Caregiver
Address
State Post Code Country
Email Address
Home Phone Mobile Phone Facsimile
SACE Number SACE Coordinator
I have had instruction and performances in the following dance styles :
Contemporary Year
Classical Ballet Year
Jazz Year
Tap Year
Streetdance Year
FOR EXAMPLE YEAR 2014 to 2018
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REFEREE DETAILS
1. NAME:
CONTACT:
DETAILS:
2. NAME:
CONTACT:
DETAILS:
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Previous Dance training school:
NAME OF DANCE TEACHER:
NAME OF SCHOOL/THEATRE GROUP:
YEAR STUDIED:
EXAMS PASSED: (IF APPLICABLE)
LIST ANY MAJOR PERFORMANCES:
Previous Performing Arts Experience: Out of School ‐ Dance, Drama, Music.
NAME OF DANCE TEACHER:
NAME OF SCHOOL/THEATRE GROUP:
YEAR STUDIED:
EXAMS PASSED: (IF APPLICABLE)
LIST ANY MAJOR PERFORMANCE:
Current Dance training out of hours school:
NAME OF DANCE TEACHER:
NAME OF SCHOOL/THEATRE GROUP:
YEAR STUDIED:
EXAMS PASSED: (IF APPLICABLE)
DAY AND TIME OF TRAINING COMMITTMENTS
LIST ANY MAJOR PERFORMANCE:
Other Arts related experience: e.g. Film, Digital Media, Visual Arts & Design. (What were you involved in? I.e. Course, personal interest etc.)
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Recreation Time
How do you spend your recreational/leisure time?
Visual Arts & Design Hrs/wk
Photography Hrs/wk
Arts related classes Hrs/wk
Film/TV Hrs/wk
Community Service Hrs/wk
Computer games/Internet Hrs/wk
Other Hrs/wk
Give Details:
Personal Statement
In the space provided, in your own writing, please say why you would like to be involved in the Certificate 111 Dance course at Charles Campbell College. Please include: Personal goals and industry pathways of interest.
