Derbyshire Pro Dance Academy

1
Dancer Name* This field is required.
First Name
Last Name
2
Dancer date of birth * This field is required.
Date
Year
Month
Day
3
Dancer age* This field is required.
4
Parent/Carer name(If child is under 18yrs)
First Name
Last Name
5
Contact phone numberMust be parent/carers if child under 18yrs
Please enter a number
Contact name and relation
6
Contact Email address * This field is required.Must be parent/carers if child is under 18yrs
example@example.com
Email Verified
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Please check your mailbox and paste the code below to complete verification
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Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
7
Emergency Contact numberIf already entered parent/carers number, please enter a secondary contact
Please enter a number
Contact name and relation
8
Please tell us a little about any previous Dance experience or trainingIf complete beginner , leave blank
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9
Tell us about experience in any other hobbies or sportsA lot of other hobbies and sports bring valuable skills to dance
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10
We will regularly post footage of classes on social media to give you an insight on what dancers are doing in class and to celebrate achievements.* This field is required.Please select 2 options below
I agree to images and videos of the dancer to be used on social media and in advertisements such as local newspapers and promotional material.
I do NOT agree to images and videos of the dancer to be used on social media and in advertisements such as local newspapers and promotional material.
I agree to images and videos of the dancer to be used in the Academies private Facebook group.
I do NOT agree to images and videos of the dancer to be used in the Academies private Facebook group
11
Is there any safeguarding or health and safety information you feel we should be aware of?Example:allergies, health problems, medications, contact arrangements, etc
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