Strictly Learn to Dance In aid of St Luke’s (Cheshire) Hospice Application Form Please fill out one application per person YOU Name: YOUR DANCE PARTNER Address: Postcode: Home No: ______________________________   Mobile No: _____________________________ Email: __________________________________ How did you hear about this event? What are your reasons for wanting to take part? We confirm that we will raise a minimum of £650 sponsorship for St Luke’s (Cheshire) Hospice. We confirm that we will pay a (fully refundable) deposit of £50 per person. We confirm that we have both read and agree to the attached terms and conditions. Signed (your signature): …….…………………...………… Signed (your dance partner): ……………………………………. Date: ……………………………………………………………. Date: …………………………………………………………………..

Terms & Conditions Please read very carefully before committing yourself Starting 16 September 2016 at 8pm, my dance partner and I commit to attending regular tuition over an 8 week period at Pritchards’ Dance Academy, School House, Burleydam, Near Whitchurch SY13 4AW. My dance partner and I are free all day on Saturday 12 November 2016 for rehearsals, hair and make-up and the Finale Show at The Grange Theatre, Hartford. We agree to pay a £50 deposit per person which is fully refundable if we complete the dance lessons and compete at the finale on Saturday 12 November. My partner and I commit to raise a minimum of £650 for St Luke’s (Cheshire) Hospice. We will endeavour to sell a minimum of 10 tickets to family and friends to come and watch the performance at The Grange Theatre on Saturday 12 November (all tickets must be bought in advance through the Grange Theatre Box Office). We understand that we will need to invest in a pair of professional dance shoes. We confirm that we are both physically fit enough to take part in St Luke’s (Cheshire) Hospice Strictly Learn to Dance 2016 competition. We will comply with all instructions given to us by the dance teachers and event organisers, and we understand that we are participating at our own risk. We understand that the Judge’s decision is final. My dance partner and I understand that places are limited and filling out the application form does NOT guarantee a place in the competition. Data Protection Act. St Luke’s (Cheshire) Hospice will process your personal data for the purpose of your entry to and participation in ‘Strictly Learn To Dance’. We may also keep you informed about our work, promotions and future events. If you would prefer not to be informed about future events please let us know by writing to the Fundraising Team, St Luke’s (Cheshire) Hospice, Grosvenor House, Queensway, Winsford, Cheshire CW7 1BH. Photography consent. By taking part in this event, you are consenting to have your picture taken in both stills and video format by the Hospice and outside sources. These images may be used indefinitely to promote the work of St Luke’s Cheshire Hospice for fundraising activities.