1st Student’s Name
Date of Birth
2nd Student’s Name
3rd Student’s Name
Address
Postcode
Phone Number
Student’s Phone Number
Email Address *
Mum’s Name
Work Phone
Mobile
Dad’s Name
I hereby give permission for my child, or myself (if 18yrs or over) to participate in dance class. I fully understand that this is at our own risk and that all care will be taken with students but no responsibility will be accepted by the school or those involved with the school. In an event of medical emergency and where a parent cannot be contacted; I authorise the dance school to seek medical advice at a medical centre or hospital.
Name Parent/Guardian *
I Agree *
Date *
Does your child have any disability or illness that should be brought to the attention of his / her tutors?
CLASS LIST (please tick appropriate box or age group)
Ballet – Graded for ExamsPre-primPrimary12345Inter FoundInterAdvPointe
Jazz – GradedPre-primaryPrimary123456InterAdv 1Adv 2
Stage Style Tap – GradedPre-primaryPrimary12345Int FoundIntAdv 1
Pointe WorkPre-PointePointe
Babies Ballet/Jazz 2-3 YearsTuesdayThursday
Tinies Ballet/Jazz 3-4 YearsTuesdayWednesdayThursday
Tiny Tappers 3-4 yearsTuesdayWednesdayThursday
Tiny Tumblers Acrobatics 2-4 yearsTuesdayThursday
Open Ballet (no exams offered)8-12 Years13 Years & Over
Open Jazz (no exams offered)8-12 Years13 Years & Over
Acrobatics4-8 Years8-12 Years13 Years & Over
Hip Hop4-8 Years8-12 Years13 Years & OverAll Boys 6-12 Years
Senior fitness and strength class
Adult’s fitness class including jazz, hip hop routines.
Would you consider allowing your child to enter examinations?YesNo
If your child has had any previous dance training please give details:
Please list for each student any medical information
