Free Trial Form - Saturday 19 June 2021
Dance & Fitness Classes @ Eastern Gymnastics Academy, Waterloo - 12.00pm to 3.00pm
Student Name
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First Name
Last Name
Student Date of Birth
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Date
Parent Name
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First Name
Last Name
Parent Email
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Address
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Contact Phone Number
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Other Siblings/Children's Names & Ages
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Register for Free Trial Lessons
Saturday 19 June 2021 - 12pm to 3.00pm
Which Dance Class/es would you like to trial?
Kindergarten to Year 1 Ballet: 12.00pm - 12.20pm
Kindergarten to Year 1 Jazz: 12.30pm - 12.50pm
Year 2 to Year 3 Jazz: 1.00pm - 1.20pm
Year 2 to Year 3 Hip Hop: 1.30pm - 1.50pm
Year 4 to Year 6 Hip Hop: 2.00pm - 2.20pm
Year 3 to Year 6 Contemporary/ Lyrical: 2.30pm - 2.50pm
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Medical Information
Do you suffer from any health complaints? Eg. asthma, allergies, diabetes,blood pressure, cholesterol, arthritis, skin disorders (acne, rashers, psoriasis, eczema) chronic fatigue, other?
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Please provide and explain.
Any other health conditions, current or past injuries?
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Disclaimer
CLASS LIABILITY RELEASE WAIVER
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www.motiondanceandfitness.com.au
Email: info@motiondanceandfitness.com.au
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