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Personal Information
Name:
Date of Birthday:
Permanent Address:
Postcode:
Tel (Day):
Tel (Eve):
Email Address:
Have you trained with Envisage before?:	Yes No
Term Time Details (if applicable)
Address:
Postcode:
Email Address:
Tel:

ETHNICITY:
White:	British Irish Any Other White
Mixed Race:	White & Black Caribben White & Black Asian White & Asian Any Other Mixed Raced
Asian or Asian British:	Indian Pakistani Bangladeshi Any Other Asian or Asian British
Black or Black British:	Caribbean African Any Other Black or Black British
Chinese or other ethnic group:	Chinese Any Other Ethnic Group Please State:

Course Details
Course Applied For:
Course Dates:

Payment of Fees
Option One	£95.00 deposit
Option Two	Full course fee
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Special needs & medical screening
Do you have any injury, illness or other condition that may affect your ability to do any physical activity required on your course?
Yes No
(if yes, please give details)
Do you have any special learning requirements?
Yes No
(if yes, please give details)

Payment Terms & Conditions (Please read carefully)
Your deposit is non refundable under any circumstances, please check the course & assessment dates & consider the course requirements before applying. Please contact us if you have any questions. If a cancellation is made at least 14 days before the start of the course, you will be able to transfer your booking & deposit to a later course where available. Except in exceptional circumstances (medical or personal), cancellations less than 14 days before the start of the course result in the deposit being lost. Once the course has started, refunds or transfer to a later course will not be given, except in exceptional circumstances (medical or personal). Whatever the circumstances, if a refund is required, you will be charged for each course day that you have attended, plus an admin fee of £25.00. The daily charge is calculated as follows: Total course fee - Deposit/No. of course days* If a suitable later course is not available, a refund will be given as described. excluding the assessment day PLEASE READ THE FOLLOWING STATEMENT AND ACCEPT BELOW* I have read & agree to the Envisage payment terms & conditions.

Payment Terms & Conditions
(Please read carefully)

Your deposit is non refundable under any circumstances, please check the course & assessment dates & consider the course requirements before applying. Please contact us if you have any questions.

If a cancellation is made at least 14 days before the start of the course, you will be able to transfer your booking & deposit to a later course where available. Except in exceptional circumstances (medical or personal), cancellations less than 14 days before the start of the course result in the deposit being lost.

Once the course has started, refunds or transfer to a later course will not be given, except in exceptional circumstances (medical or personal). Whatever the circumstances, if a refund is required, you will be charged for each course day that you have attended, plus an admin fee of £25.00. The daily charge is calculated as follows:

Total course fee - Deposit/No. of course days*

If a suitable later course is not available, a refund will be given as described.
*excluding the assessment day

PLEASE READ THE FOLLOWING STATEMENT AND ACCEPT BELOW

I have read & agree to the Envisage payment terms & conditions.

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