Nurturing Talented Young Dancers & Bursary Awards Venue: The Lowry Theatre, Pier 8, The Quays, Salford, M50 3AZ Sunday 21st January 2018 Return your form to: Courses, ISTD, 22-26 Paul Street, London EC2A 4QE

We ask that students bring their own snacks, drinks and lunch as required.

COURSE DETAILS

Student ClassesPrice per day per student £25

includes FREE entry to the Bursary AwardsAge Genre Time Please Tick 9-11 yrsSuitable for students at Grades 2 & 3 level*SOLD OUT

Ballet 10:30-11:30

Contemporary 11:45-12:45

Jazz 13:45-15:0012-15 yrsSuitable for students at Grades 4 to 6 & Inter Foundation level*SOLD OUT

Jazz 10:30-11:30

Ballet 11:45-12:45

Contemporary 13:45-15:0016-18 yrsSuitable for students at Intermediate and above level*SOLD OUT

Contemporary 10:30-11:30

Jazz 11:45-12:45

Ballet 13:45-15:00

Bursary Awards 15:45 – 18:00

I accept my FREE Bursary Awards ticket and plan to attend

*SOLD OUT - If you would like to be added to the cancellation waiting list please complete the booking form below. We will be in contact if a space becomes available.

Accompanying parents/guardians can purchase their own Bursary Award tickets for £15 by downloading a booking form from https://www.istd.org/courses-and-training/uk-courses-congresses-and-summer-schools/

STUDENT DETAILSFull Name: Click here to enter text. Date of birth (DD/DD/YY) & Grade level: Click here to enter text.

Do you have any allergies, injuries, disabilities or mobility/access requirements of which the ISTD should be made aware?

Yes No Details: Click here to enter text.

CONTACT DETAILSParent/Guardian Title & Full Name (if under 18): Click here to enter text.

Full Address & Postcode: Click here to enter text.

Contact No: Click here to enter text. Alt Contact No: Click here to enter text.

Email: Click here to enter text.

TEACHER DETAILS Teachers' Name: Click here to enter text. Contact No: Click here to enter text.

Name of School: Click here to enter text.

PROGRAMME OF EVENTS - Sunday 21st January 2018Registration - 10:00 - 10:30 / Lunch Break 12:45 - 13:45 / Break 15:00 – 15:45 / Bursary Awards 15:45 - 18:00

ACCOMPANYING ADULT (if student is under the age of 18)

TICK IF: Parent/Guardian Teacher

Or complete below if neither of the above:

Title & Full Name: Click here to enter text.

Relationship to student: Click here to enter text. Contact No: Click here to enter text.

PAYMENT DETAILS

Amount: Click here to enter text.

CHEQUE: I have enclosed a cheque made payable to the ‘ISTD’

CREDIT/DEBIT CARD (All major credit cards are accepted, except American Express): You will receive an email link to pay by card online within 2 days working days of your booking being processed. Alternatively contact the Education & Training Dept on 020 7377 1577 or at coursebookings@istd.org

BANK TRANSFER: Please reference your payment clearly with ‘ET DEPT’ and your name. Do not forget to include a copy of the bank transfer with your submission/application. Please send payment to:Bank: National Westminster BankBranch: Finsbury Square BranchAddress: PO Box 549, 78 Finsbury Pavement, LONDON EC2A 1JA, UKSort Code: 60-08-23Account Number: 80699928Account Name: ISTDIBAN BIC: NWBK GB 2LIBAN: GB 89 NWBK 600 823 806 999 28

CONTINUED ON NEXT PAGE

BOOKING CONDITIONS All fees must be paid in full with cleared funds at least 7 days before a course begins. Payment will not be accepted on the

day of the course. Bookings cancelled less than one month before the start of the course will not be refunded unless a medical certificate is

provided or under exceptional circumstances. The ISTD also reserve the right to retain all or part of the course fee should the cancellation be made with more than one month’s notice.

The ISTD will not refund any incurred costs (such as travel and accommodation) unless the event is cancelled by the ISTD less than three weeks before the start date of the event and the delegate has received a confirmation email/letter. The ISTD will endeavour to send formal confirmation emails/letters 21 days prior to the event date.

The ISTD has the right to refuse applications on the grounds of health and safety or if acceptance would contravene its Regulatory Authority Approval.

Delegates are responsible for their own personal property. The ISTD cannot accept any responsibility for theft, loss or damage caused to personal effects

Filming or photography of the event is not permitted without written permission being provided in advance by the ISTD. Photographs/film may be taken throughout the event by an official representative of the ISTD for publicity purposes.CONSENT & RELEASE FORM The ISTD will not take responsibility for the safety of children and students outside the venue. Participants must be

accompanied by the Accompanying Adult specified on the booking form if under the age of 18. The specified Accompanying Adult(s) will only be allowed into the dance space in the case of an emergency. ISTD staff and lecturers will take responsibility for participants when inside the dance space. Photographs/film may be taken throughout the event by an official representative of the ISTD for publicity purposes.

ISTD is committed to the principle that the interests and welfare of participants taking part in dance activities is paramount. To comply with the Data Protection Act 1998, ISTD needs your permission before we take any photography or video of you.

By acknowledging and agreeing to these terms I consent to ISTD photographing or videoing me at this event. I can confirm that I have been made aware that these images or video could be used in dance related publications, the ISTD website, at future events and broadcast on social media or video streaming services. I give the ISTD permission without time limit to use this photography or video (including facial images) worldwide on any medium.I will observe the terms and conditions and agree to the consent and release as listed above, and confirm that I am medically fit to take part.

IF PARTICIPANT IS UNDER THE AGE OF 18, THIS SECTION MUST BE SIGNED BY THEIR PARENT/GUARDIAN.

Name: Click here to enter text. Date: Click here to enter text.

Please return your completed application form and payment to: Education & Training Department, Imperial Society of Teachers of Dancing, Imperial House, 22/26 Paul Street, London EC2A 4QE Email: coursebookings@istd.org * Tel: +44 (0)20 7377 1577 * Fax: +44 (0)20 7247 8309

OFFICE USE ONLY INIT:___________________

CC □ BACS □ PH □ AMT: Date: COM:

REC □ Date: BKG □ Date:GL Code: Folio No.FIN Date: