Fairy Dance Class Enrolment

Child's Details
Child's First Name*
Child's Last Name*
Child's Age*
Child's Birth Date*

DayMonthYear
Date

Parent/Guardian's Details
Parent/Guardian's First Name*
Parent/Guardian's Last Name*
Relationship to Child*
Email*

Confirmation Emailexample@example.com
Postal Address*

Street Address

Street Address Line 2

SuburbState / Province

Postcode
Home/Work Telephone
Mobile*

Class Enrolment
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

About Your Child
Does your child have any existing medical conditions?*

NoYes
If yes, please give specific details of this condition. How can we best manage this condition while the student is in class?
Does your child have any existing special needs?*

NoYes
If yes, please give details of these needs and how we can bet manage these during a lesson.

We're almost done...
How did you hear about The Fairyshop?*

Word of MouthWebsite/GoogleFacebook/InstagramIn person at the studioOther
Occasionally we take photos or videos of our classes for promotional purposes. Week 10 of each term we allow parents and special guests to come in and watch and film the final class for the term. Are you happy for your student to be included in this?*

YesNoI would like to discuss this further

Payment
PRICING

1 X Class =$180.00 per term

2 X Classes = $360 per term

3 X Classes = $535 per term

4 X Classes = $710 per term

Unlimited = $850 per term

FAIRY CLASSES*

Please select the number of classes per term/per child$180.00AUD

10% Off Term 4 Re-enrollment

Quantity
Item subtotal:$0.00AUD

Total $0.00AUD

Credit Card

Please verify that you are human*
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