The Workshop Clubs: Self-Referral Bursary Form

Please complete this form and a member of the Workshop's Participation Team will be in contact to discuss your application.

Please enable JavaScript in your browser to complete this form.

Participant Name

First

Last

Participant Date of Birth

Participant Age

Phone Number

Address

Address Line 1

City

State / Province / Region

Postal Code

Emergency Contact

applying require of

Emergency Contact Name & Relation

Parent/Guardian Email (if under 18)

Please state which class/course you are applying for

Please state why you require a bursary and how the participant would benefit from taking part in this class/course?

Signature

Clear Signature

Date of application

take part