Janice Marshall Stage School Registration Form

Student Registration 2020-2021

Fill in the information below
Name of Student *

First Name Last Name
Student D.O.B *

Day Month Year
Date
Home Phone Number

Area Code Phone Number
Parent/ Guardian Mobile Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City County

Postal Code Country
Contact E-mail
Gender *

Male Female
Classes (Please select classes for registration)

Boogie Babies Nursery Ballet & Tap Nursery & Pre-School Class (Dreghorn) Pre-Primary Class (Dreghorn) Primary Class (Dreghorn) Ballet Theatre Workshop Hip Hop Stretching Modern Tap Musical Theatre Lyrical
Current Students

Please select the grade/class from the dropbox menu that the student attended last year (2019-2020) excluding Boogie Babies, Nursery & Dreghorn Classes.
Ballet
Modern
Theatre Workshop
Musical Theatre
Lyrical
Hip Hop
Tap
Emergency Contact Information

Please provide information for two emergency contacts
Emergency Contact #1 *

First Name Last Name
Emergency Contact #1 Phone Number *

Area Code Phone Number
Relationship to student *
Emergency Contact #2 *

First Name Last Name
Emergency Contact #2 Phone Number *

Area Code Phone Number
Relationship to student *
Medical Information
Does the student have any pre-existing medical condition(s) and/or needs or requirements that our staff need to be aware of? *
If YES, please provide information.
Additional Information
If there is any additional information that you would like to make us aware of, please indicate in the comment box below.
*Please note that all information provided on this registration form will be kept strictly confidential. Any information you have given us will be treated with the upmost care.
For any enquires regarding registration, please feel free to reach out to us at jmssreg@gmail.com
Signature

Parent/Guardian Clear
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Student Registration 2020-2021

Current Students

Emergency Contact Information

Medical Information

Additional Information