Ultimate Dance NRG Student Registration Form

Student Registration Form- Summer Club

Fill out the form carefully for registration
Student Name & Age*

First NameLast NameAge
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Email*
example@example.com
Parent/Guardian Mobile Number *

Area Code (excluding 0 )Phone Number
Parent/Guardian Number (2)

Area Code (excluding 0)Phone Number
Class Attending*
Medical Conditions
Photography & Filming Consent.

For marketing and publicity purposes, Ultimate Dance NRG may take photos during classes, workshops and showcases and other performances. These may be published on social media channels, websites and other promotional materials.

Please advise if you DO give consent for the named student above to appear in such publicity.
- Images and videos will be held in accordance with GDPR
- Consent can be withdrawn at any time by contacting us in writing.
CONSENT FOR PHOTOGRAPHY & FILMING (PLEASE TICK)*

I GIVE PERMISSIONI DO NOT GIVE PERMISSION
Thank you for completing your enrollment form. Information provided will only be used to contact you in case of emergency, class information/ updates and any details in relation to events in which the named student may be participating in. Your information will not be shared to any third party. You have the right to withdraw consent at any time. Please contact us in writing. Please ensure you keep your contact information up to date by advising staff at the session you attend.

Recipents details:

Ultimate Dance NRG LTD

Company No. 08187352

Telephone: 07950 475476

Email: admin@ultimatedancenrg.com
Should be Empty:

Student Registration Form- Summer Club