Application Form

Name (Mr/Mrs/Miss)

Address

Postcode Telephone

Do you require a Town Hall Rear Car Park Permit YES/NO If YES, can you please let me have your Car Reg. No. ______Do you already have an existing Car Park Permit YES/NO

I would like to attend the following activity/activities (Please tick as applicable)

Burton Town Hall

Monday

Poetry and Playreading 

Tuesday

Craft  

Wednesday

Craft 

Friday

Art (10.00 am) Art (12.00 noon)  Art (2.00 pm) 

Waterside Community Centre, Stapenhill

Monday – Upholstery  Thursday – Zumba   Uttoxeter Heath Community Centre Wednesday – Exercise to Music 

The Odd Fellows, Unity Hall Kingstone with Gratwich Village Hall Thursday – Singing for Pleasure  Monday – Zumba Gold  Thursday – Art 

Please send your completed form with Postal Order or Cheque (address/bank card details on reverse) made payable to “East Staffordshire Borough Council” to:

Mrs J Smith, Sports Development Service Commissioning, East Staffordshire Borough Council The Maltsters, Wetmore Road, Burton upon Trent, Staffs DE14 1LS

Your receipt will be issued to you at your class by the tutor, when you attend.

Total Cost £ ______Cheque/Postal Order Date ______

Are you male or female? Please tick one box only

Male...... Female......

What is your ethnic group? Please tick one box only

White Black or Black British Chinese or any other background British Caribbean Chinese I Irish African Roma/Gypsy Any other White background Any other Black background Traveller of Irish ( please write in) (please write in) Heritage

Mixed Asian or Asian British White and Black Caribbean Indian White and Black African Pakistani White and Asian Bangladeshi Any other Mixed background Any other Asian background Other Ethnic Group ( please write in) (please write in) (please write in)

How did you hear about the Active Adults Activity Programme

ES News/Local Press Friends/Family G.P. Surgery   Lifestyle Advisor  Other (please state) ______

Unfortunately, no refunds are available

I understand that under the Data Protection Act of 1998, my information overleaf will solely be used by East Staffordshire Borough Council’s Sports Development Team. Only ‘Zumba’ and ‘Zumba Gold’ information will be shared with the Zumba Instructors for health and safety purposes.

Please sign below:- Applicants Signature

East Staffordshire

Borough Council

Activity Programme Spring 2014

The Active Adults Programme is For further information please telephone:- organised by East Staffordshire Borough Joanne Smith, Sports Development Administrator on (01283) 508191 or email Council’s, Service Commissioning. on [email protected]

The aim of the programme is to give adults the opportunity to lead a more active and healthy Price List for Active Adults (10 Wks) lifestyle by getting involved in this exciting East Staffordshire Residents:- programme of different activities. Activities £17.50 for first activity normally run over three, 10- week terms (like £17.50 for second activity school terms). We encourage all new members £ 4.20 for the third and any to visit and take part within the classes before subsequent activities joining. This gives you the chance to see if it is Non East Staffordshire Residents the right class for you. You may join at any time £20.85 per activity during the term.

East Staffordshire Walking for Health Cheques or Postal Orders Only

New members – please feel free to try any East Staffordshire Borough Council, Sports of the classes before enrolling. Development Team works in partnership with the Ramblers, who work closely with Macmillan If you wish to visit art, craft or upholstery Cancer Support on this project. All walks take please call 01283 508191 to find out what place within the local community and are lead by you will need to take to the class. trained Volunteer Walk Leaders on a weekly basis. The aim of the programme is to promote You may join Active Adults at any walking as a free, fun and effective form of time during the term, please call for exercise. more details.

Outline of Active Adults Programme

Art A course where participants will have the opportunity for independent development of their artwork, with encouragement to develop and further their ideas. Demonstrations are also given on all types of different techniques by our experienced local Art tutor. Lesson plan available. Craft Learn new skills in handicraft work including stitchery and other media/techniques. Exercise to Music Incorporates movements such as stretching, balance and good posture. Starts off seated and then moves at a gentle pace whilst standing to a wide variety of music. Good fun – wear comfortable clothing/shoes Zumba Zumba is the only Latin inspired dance fitness programme that is easy to do, effective, totally exhilarating and great fun Zumba Gold Zumba Gold offers a modified Zumba routine which is easy to follow, low impact and great fun. Poetry & Play- This group caters for all those who have a love of words and who like to reading keep the mind active. Topical discussion and reading catering for a wide variety of tastes. Singing for Come along and join in with this enthusiastic group and their enjoyment Pleasure for music and song. Upholstery Using modern and traditional techniques learn basic and advanced upholstery to transform your own project. New members please contact 01283 508191 to find out what equipment you will need for the class.

East Staffordshire Borough Council’s Active Adults Activity Programme - Class Details

Day Activity Time Venue Tutor Monday Upholstery 9.30 am to11.30 am Waterside Community Centre Lindy Rodgers Monday Zumba Gold 10.00 am to 11.00 am Kingstone with Gratwich Village Hall Pat Miller (Main Hall) Monday Poetry and Playreading 2.00 pm to 4.00 pm Town Hall Group Participation Weaver Room Tuesday Craft 10.00 am to 12.00 pm Town Hall – Dove Room/Lingen Room Gill Bird and Heather Lowe Wednesday Craft 9.45 am to 11.45 am Town Hall – Dove Room/Lingen Room Gill Bird Thursday Art 7.00 pm to 9.00 pm Kingstone with Gratwich Village Hall Laura Giles Wednesday Exercise to Music 10.30 am to 11,30 am Uttoxeter Heath Community Centre Laura Pyatt Thursdays Zumba 1.30 pm to 2.30 pm Waterside Community Centre Livi Jenkin Thursday Singing for Pleasure 2.00 pm – 3.00 pm The Odd Fellows, Unity Hall Arthur Tipper Friday Art 10.00 am to 12.00 pm Town Hall, Lingen Room/Dove Room Laura Giles Friday Art 12.00 noon – 2.00 pm Town Hall Lingen Room/Dove Room Laura Giles Friday Art 2.00 pm – 4.00 pm Town Hall, Lingen Room/Dove Room Laura Giles

Waterside Community Centre, Heath Road, Stapenhill, Burton upon Trent, Staffs DE15 9LF The Odd Fellows, Unity Hall, All Saints Road, Burton upon Trent, Staffs DE14 3LS Uttoxeter Heath Community Centre, Uttoxeter, Staffs ST14 7DT Kingstone with Gratwich Village Hall, Blythe Bridge Bank, Kingstone, Staffs ST14 8QN Burton Town Hall, St Paul’s Court, Burton upon Trent, Staffs DE14 2EB

Please note: Car parking available at the front of the Town Hall for 2 hours only. Permit holders only to use the car park at the rear of the building – permits are available by contacting Joanne Smith on 01283 508191.

This programme may be subject to change at short notice – due to bad weather etc

Spring Term 2014 – Active Adults Classes

Burton Town Hall St Pauls Square, Burton upon Trent, DE14 2EB

Poetry and Playreading - (Monday) 2.00 pm to 4.00 pm

January February March 20th, 27th 3rd, 10th, 24th 3rd, 10th, 17th, 24th, 31st

Craft – (Tuesday) 10.00 am to 12.00 pm

January February March April 21st, 28th 4th, 11th, 25th 4th, 18th, 25th 1st, 8th

Craft - (Wednesday) 9.45 am – 11.45 am

January February March April 22nd, 29th 5th, 12th, 26th 5th, 19th, 26th 2nd, 9th

Art (Friday) 10.00 am to 12.00 pm or 12.00 pm to 2.00 pm or 2.00 pm to 4.00 pm – 3 separate classes available

January February March April 24th, 31st 7th, 14th, 28th 7th, 21st, 28th 4th, 11th

Please note: Car parking available at the front of the Town Hall for 2 hours only. Permit holders only to use the car park at the rear of the building – permits are available by contacting Joanne Smith on 01283 508191.

School Half Term week commencing 17th to 21st February (no classes)

Waterside Community Centre, Heath Road, Stapenhill, Burton upon Trent DE15 9LF

Upholstery (Monday) 9.30 am to 11.30 am

January February March 20th, 27th 3rd, 10th, 24th 3rd, 10th, 17th, 24th, 31st

This programme may be subject to change at short notice

Spring Term 2014 – Active Adult Classes

Waterside Community Centre (Continued) Heath Road, Stapenhill, Burton upon Trent, DE15 9LF

Zumba (Thursday) 1.30 pm to 2.30 pm

January February March April 23rd, 30th 6th, 13th, 27th 6th, 13th, 20th, 27th 3rd

The Odd Fellows, Unity Hall, All Saints Road, Burton upon Trent DE14 3LS

Singing for Pleasure (Thursday) 2.00 pm – 3.00 pm

January February March April 23rd, 30th 6th, 13th, 27th 6th, 13th, 20th, 27th 3rd

Uttoxeter Heath Community Centre, Uttoxeter ST14 7DT

Exercise to Music (Wednesday) 10.30 am to 11.30 am

January February March April 22nd, 29th 5th, 12th, 26th 5th, 12th, 19th, 26th 2nd

Kingstone with Gratwich Village Hall, Kingstone ST14 8QN

Zumba Gold (Monday) 10.00 am to 11.00 am

January February March 20th, 27th 3rd, 10th, 24th 3rd, 10th, 17th, 24th, 31st

Art (Thursday) 7.00 pm to 9.00 pm

January February March April 23rd, 30th 6th, 13th, 27th 6th, 13th, 20th, 27th 3rd

New Members please note when joining art, craft, or upholstery, please telephone 01283 508191 or email [email protected] to find out what equipment etc you will need to take to the class

This programme may be subject to change at short notice