The Garage Classes & Companies: Self-Referral Bursary Form

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

Participant Name *

First

Last

Participant Date of Birth *

Participant Age *

Phone Number *

Email *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Emergency Contact *

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

class/course Please this

Date of application *