REGISTRATION FORM

Full Name____________________________

Date of Birth______________________

Ethnic Classification_______________________

Address_______________________

            _______________________

            _______________________

             _______________________

Details of any medical conditions or allergies:

________________________________________________________________________

________________________________________________________________________

Details of any special needs or learning difficulties:

________________________________________________________________________

________________________________________________________________________

Contact telephone numbers

Home: ________________________________

Mobile: ________________________________

Email: ________________________________

I give permission for teachers and assistants to give physical corrections during dance tuition. 

 I have read and understand the terms and conditions of the dance academy.

I do/do not give permission for my child to be included in photographs/ videos for the academy website or any other advertising. 

Signature of parent/guardian_________________________Date_________________