Boys Move Revisited 2017
2017 Application Form
Friday 17 February 2017
Surname:
First Names:
Address:
Postcode:
Telephone No.(incl. code):
Email Address:
Date of Birth:
Age:
Nationality:
Contact name in case of emergency:
Relationship to child:
Telephone no. (incl. code):
MAILING LIST
Please include / do not include (delete as appropriate) my email on your mailing list to receive notification of
future Widening Participation & Access events.
Email:
Central School of Ballet may take photographs and/or film footage of this event for publicity purposes. To
comply with the Data Protection Act 1998 we need your permission before any images of your child are taken.
I give / do not give (please delete accordingly) permission for my son to be photographed and/or filmed
during this event, and for the resulting images to be used by Central School of Ballet.
Signed: ____________________________________ (parent/guardian)
Date:
_________________
1
Central School of Ballet is proud to be a partner school of the Prix de
Lausanne
and an affiliate of the Conservatoire for Dance and Drama.
TRAINING TO DATE
Have you studied:
YES
NO
YES
NO
Most recent examination taken. Please state examining
board, level, date taken and result
Classical Ballet
Capoeira
Other (Please state)
About you:
If yes, please specify
Do you have any
injuries?
Do you have any health
conditions or allergies
we should be aware of?
Have you previously
attended any dance
courses?
Name and addresses of dance schools, teachers and date attended starting with your current teacher (please
continue on an additional sheet if necessary):
Name of Dance Teacher
Address of Dance School
Dates Attended
Hours per
week
Does the participant attend a state school? YES/NO (If yes, please give the name, address and postcode
below)
Name:
Address:
2
Central School of Ballet is proud to be a partner school of the Prix de
Lausanne
and an affiliate of the Conservatoire for Dance and Drama.
Postcode:
Boys Move Revisited 2017
Application Form
PAYMENT
Course amount: £15.00
Cheques should be made payable to ‘Central School of Ballet'. Please print the participant’s name on the back
of the cheque. Please note that an administrative charge of £25 will be levied against any cheques returned by
the bank.
Alternatively you can pay online through our website
http://www.centralschoolofballet.co.uk/coursesonlinepayment.php
You can also call the Widening Participation & Access Department during office hours
(9.30am-5.00pm) and pay by credit/debit card over the telephone.
Cheque Enclosed 
Credit Card 
Date.........................
Online

WorldPay Transaction
ID..........................
PLEASE NOTE: When paying online you will receive a notification of payment from WorldPay. This notification
does not indicate that a place has been awarded on the course. Only a notification of acceptance from the
Widening Participation and Access Department by email confirms an allocated place on the course. If you
haven’t received such confirmation seven days after submission please contact the Widening Participation and
Access department on 0207 837 6332.
Completed application forms should be sent to:
Widening Participation & Access
Central School of Ballet
10 Herbal Hill
Clerkenwell Road
London, EC1R 5EG
Please enclose the following with your completed application form:
- Equality & Diversity Form
DECLARATION
This is to certify that to the best my knowledge the information provided in this document is accurate at the
time of writing. I accept that any amendment to the information provided after acceptance and
acknowledgement of this application could result in the loss of a course place and deposit. I have also read and
understand the Refund Policy detailed on page 6 of the application form.
3
Central School of Ballet is proud to be a partner school of the Prix de
Lausanne
and an affiliate of the Conservatoire for Dance and Drama.
Signed (Parent/Guardian):
Print Name:
Date:
Please note that there are restricted numbers on the course
4
Central School of Ballet is proud to be a partner school of the Prix de
Lausanne
and an affiliate of the Conservatoire for Dance and Drama.
Equality and Diversity Information Form
Central School of Ballet welcomes applications/participants from all sections of the community
regardless of ethnicity, gender, religion or disability. The information you give in this section is used
for statistical and monitoring processes only and to ensure that we deliver an outreach programme
for all sectors of the community.
Age of Participant: ............
How old were you when you started ballet? .............
Did either of the participant’s parents/guardians attend higher education? Yes □ No □
Gender:
Male 
Female 
Please tick the box or boxes which best describe your ethnic or cultural background:
White British
I do not wish to give this information
White Irish
Other Asian background
Black or Black British –Caribbean
Mixed – White and Black Caribbean
Black or Black British – African
Mixed – White and Black African
Other Black background
Mixed – White and Asian
Asian or Asian British – Indian
Other Mixed background
Asian or Asian British – Pakistani
Arab
Asian or Asian British – Bangladeshi
Other Ethnic background
Chinese
Please describe.................................
Which of the following statements about disability is most appropriate to you? Please tick the
..........................................................
appropriate box(es).
No known disability
Long-standing illness or health
condition, e.g. epilepsy
Blind / serious visual impairment
Two or more impairments and/or
medical conditions
Deaf / serious hearing impairment
Social/communication impairment,
e.g. Autistic Spectrum
Physical impairment or mobility
A specific learning difficulty e.g.
issues
dyslexia
Personal care support
A disability, impairment or medical
condition not listed above
Mental health condition
I do not wish to give this information
Household Income - Please indicate the income bracket which your household falls into:
Less than £25,000 
Less than £43,000  Less than £60,000  Over £60,000 
For further information about Central School of Ballet please go to
5
Central School of Ballet is proud to be a partner school of the Prix de
Lausanne
and an affiliate of the Conservatoire for Dance and Drama.
www.centralschoolofballet.co.uk
6
Central School of Ballet is proud to be a partner school of the Prix de
Lausanne
and an affiliate of the Conservatoire for Dance and Drama.
Boys Move Revisited 2017
Information Sheet
NOTE: Please read this document carefully and retain for your reference.
DRESS
Those who are beginners to dance, should wear something comfortable and suitable to dance in. Those who
regularly attend class, you should wear your usual ballet uniform. All students may wish to bring tracksuits for
Capoeira and for keeping warm between classes. For all other classes, no footwear will be required.
TIMETABLE
Classes will begin at 10.30am or 11.00am and will finish at 4.30pm or 6.00pm dependent on the group you are
allocated. We recommend that you arrive 30-45 minutes before class starts. Please also allow time to warm-up
before each class.
Students will be assigned a group prior to the start of the course. You will be notified of your group when you
receive the final timetable by email closer to the date of your selected course. Groups are chosen at our
discretion and our decision is final.
OUR LOCATION
Central School of Ballet
10 Herbal Hill
Clerkenwell Road
London
EC1R 5EG
Central School of Ballet is located near Farringdon tube and Overground station. Chancery Lane tube is also
within ten minute walk.
7
Central School of Ballet is proud to be a partner school of the Prix de
Lausanne
and an affiliate of the Conservatoire for Dance and Drama.