New Student Enrolment

New Student Enrolment

Please complete all boxes
Name of student enrolling*

First NameLast Name
DAte of birth of student*

DayMonthYear
Date
Name of parent/guardian (under 18)

First NameLast Name
Phone details*

Mobile NumberHome Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
what class are you enrolling in
does the student have any medical conditions

Yes, and it may affect performance in lessonsYes, but it will not affect performance in lessonsNo
If answered "YES" what is the medical condition Medical condition. If medication is needed in lessons please specify Medication needed.
do we have permission to photograph the student ?
Do you give permission for SDTA teachers to administer first aid if needed

YesNo
Data Protection

Synergy Dance Training Academy will process your confidential information – which includes students and Parents/Guardians names, contact details, date of birth, relevant medical history, only for the purposes listed below.
- For the purpose of administration in connection with dance classes
- Supply of information and examination paperwork to NATD/IDTA
- Supply of information and registration paper to competition organisations/companies
The data will be stored securely with the use of password protection, and will not be stored longer than necessary and solely for the completion of those business activities.
i consent to the above

YESNO
prefered contact method

Mobile/home NumberEmail
Signature

Clear
Should be Empty: