Registration Form

Registration Form

Please complete, sign and submit this form once you are satisfied with the Terms and Conditions laid down by Centre Stage Dance and Drama Ltd.
Child’s name: *

First name Last name
Child’s date of birth: *

Month Day Year
Child’s home address: *

Street Address Line 1

Street Address Line 2

City

Postal Code
Child’s second home address (if required):

Street Address

Street Address Line 2

City

Postal / Zip Code
Your name: *

First Name Last Name
Relationship to child: *
Your mobile number: *

Area Code Phone Number
Your email address: *
Second contact name:

First Name Last Name
Relationship to child:
Their mobile number:

Area Code Phone Number
Their email address:
Please select performing art style(s) undertaken: *

Ballet Tap Modern Acro Contemporary Urban Drama
Are there any Medical, Educational or Family circumstances we should be aware of?
If so, please give details above. This information will remain confidential.
Signature *

Clear
Should be Empty: