6 Eunice Grove, Chesham,

Buckinghamshire HP5 1RL

Telephone: 020 8952 6010
Email: chrystelarts@waitrose.com

E N ROLMENT FORM
This form must be completed and returned, with the deposit for two trial classes, before attending any
classes, together with a signed copy of the School’s Terms and Conditions and consent form.

All correspondence should be sent to Chrystel Arts at the above address.

Cheques should be made payable to "Chrystel Arts".

Please complete all the details below - in CAPITAL LETTERS - and delete as appropriate

Pupil’s Surname:

Pupil’s Forenames:

Mother’s Surname: (if different)

Sex: Male / Female Date of birth: School year:

Name of sibling already at Chrystel Arts:

Home address:

Postcode

Home telephone number:

Mobile number:

Email address:

Classes you wish to enrol for:

Are there any medical conditions/allergies/medications which you would like us to be aware of? YES / No

If YES please give details including medication

CA-08/16