DANCENTRE ENROLMENT FORM 2024

DANCENTRE

ENROLMENT FORM 2024
Date

DayMonthYear
Date of Submission
STUDENT INFO
STUDENT NAME

First NameLast Name
Phone Number

Area CodePhone Number
DATE OF BIRTH

DayMonthYear
Date
AGE
PLEASE LIST DANCE CLASSES & LEVEL ATTENDING OR TICK CLASSES FROM LIST BELOW
DANCE CLASSES

PRESCHOOL BALLET - SAT 9:15 - 10:00AMBEG BALLET / JAZZ - SAT 9:00 - 10:00AMBEG BALLET / JAZZ - TUES 4:00 - 5:00PMREADY SET DANCE 1 (2-3YRS) - SAT 10:00 - 10:45AMREADY SET DANCE 1 (2-3YRS) - SAT 10:45 - 11:30AMREADY SET DANCE 2 (4-5YRS) - SAT 11:30 - 12:30READY SET DANCE LEVEL 1 & 2 - THURS 9:15 -10:00 AMBALLET / JAZZ LEVEL 1 - TUES 4:00 - 5:00PMBEG TAP LEVEL 1 - TUES 5:00 - 5:30PMJUNIOR BOYS HIP HOP - WED 4:15 - 5:00PMJUNIOR HIP HOP - WED 5:00 - 6:00PMJUNIOR CONTEMPORARY - THURS 4:00 - 4:45PMJAZZ 3BALLET 3JAZZ 4BALLET 4TAP 4INTER HIP HOPINTER CONTEMPORARYBALLET 6JAZZ 6BALLET 7JAZZ 7TAP 7PRE - ELEM BALLETJAZZ 9OPEN JAZZSENIOR HIP HOPSENIOR CONTEMPORARYSTRETCH & STRENGTHADULT HIP HOP - TUES 7-8PMBARRE BODY FLOW & TONE - THURS 2-3PM
PARENT / GUARDIAN INFO
NAME

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState

Post Code
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
EMERGENCY CONTACT
Name

First NameLast Name
Phone Number

Area CodePhone Number
PLEASE LIST ANY KNOWN ILLNESSES & DETAILS OF ADMINISTRATION OF MEDICATION WHERE THESE MAYBE RELEVANT TO THE STUDENT UNDERTAKING DANCE CLASSES
EMERGENCY / INJURY DISCLAIMER

In the event of an emergency I do hereby give permission to the representative of DANCENTRE to use his/her discretion in determining the most appropriate course of action with regard to the best interests of the above mentioned student.
YESNO
DANCENTRE MARKETING AUTHORITY

I give permission for my child / children's photograph to be taken during classes / performances for the purpose of the use of the images in any Dancentre advertising. This may include website, brochures, display or other marketing materials at Dancentre's discretion.
YESNO
Dancentre will not be liable for any loss, illness or injury incurred by the student/s while the student/s are attending Dancentre classes.
Signature

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DANCENTRE

STUDENT INFO

PARENT / GUARDIAN INFO

EMERGENCY CONTACT

EMERGENCY / INJURY DISCLAIMER