Shoot
YOUR
Story!
Age of Applicant
Date of Birth
Name of Parent/Guardian/Sponsor
Phone
Emergency Contact/Mobile
I agree to my son/daughters participation in Photo Academy and know of no medical reason why
they should not do so.
The deadline for applications is: 5 pm on Monday 11th May 2015
I enclose the course fee of 60.00 (towards exhibition materials - cheques payable to Socit Jersiaise).
I understand that if a place on the course is not available this money will be returned to me in full.
I understand that the fee is not refundable should I withdraw my son/daughter during the course.
In cases of genuine hardship please contact the organisers.
I undertake to inform the organisers if any of the above details change before or during the period of the
course.
SIGNED_________________________NAME (caps)__________________________Date__/___/20____
PHOTO ACADEMY