‘Strictly Learn to Dance’ Application Form Name: …………………………………………………………………………………………………. Address: ……………………………………………………………………………………............... …………………….…………………….………………………………………………………………. Email: ……………….………………………………………………………………………………….. Phone number: ………………………………………………………………………………………. Mobile number: ……………………………………………………………………………………… Gender: …………………… Age: …………………… Occupation and place of work: …………………………………………………………………. Height: …………………… Weight: …………………… Dance Experience: Novice Intermediate Advanced Are you able to commit to a two hour rehearsal every week for 10 weeks, from Sunday January 18th until Sunday March 22nd between 4pm and 6pm? Yes No Do you have any disabilities that we should be aware of? Yes No If yes, please explain... ……………………………………………………………………………………………… Are you happy to sell 15 or more tickets at £10 for the Dance Finale to your friends and family? Yes No Are you able to raise a minimum of £250 sponsorship money?
Yes
No
Why would you like to take part in Strictly Learn to Dance in aid of Dove House Hospice? …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… Signed……………………………………………………………………………Date………………