2022 ENROLLMENT FORM
EPPING
STUDENT DETAILS
STUDENT NAME
First Name
Last Name
STUDENT D.O.B
-
Month
-
Day
Year
Date
STUDENT CONTACT NUMBER (IF APPLICABLE)
-
Area Code
Phone Number
STUDENT EMAIL (IF APPLICABLE)
example@example.com
STUDENT ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT DETAILS
PARENT 1 NAME
First Name
Last Name
PARENT 1 PHONE NUMBER
-
Area Code
Phone Number
PARENT 1 EMAIL
example@example.com
PARENT 2 NAME
First Name
Last Name
PARENT 2 PHONE NUMBER
-
Area Code
Phone Number
PARENT 2 EMAIL
example@example.com
IF YOU PROVIDED A WORK EMAIL, PLEASE PROVIDE A SECONDARY EMAIL ADDRESS IN THE CASE OF 'OUT OF OFFICE' ALERTS
example@example.com
EMERGENCY CONTACT (IN CASE OF EMERGENCY PICK-UP)
CONTACT 1 NAME
First Name
Last Name
CONTACT 1 PHONE
-
Area Code
Phone Number
RELATIONSHIP TO STUDENT
CONTACT 2 NAME
First Name
Last Name
CONTACT 2 PHONE
-
Area Code
Phone Number
RELATIONSHIP TO STUDENT
SIGNED
FULL NAME
First Name
Last Name
MEDICAL HISTORY
*PLEASE NOTE THIS DOES NOT AFFECT YOUR CHILD'S ENROLMENT, IT IS SIMPLY SO THAT STAFF ARE AWARE OF ANY MEDICAL CONDITIONS THAT MAY AFFECT THE STUDENT WHILE THEY ARE AT THE STUDIO*
DOES YOUR CHILD SUFFER FROM ANY OF THE FOLLOWING (SELECT ANY THAT APPLY)
ASTHMA
EPILEPSY
ANAPHYLAXIS
MILD - SEVERE ANXIETY
AUTISM
ASPERGERS
ADD
ADHD
DOES YOUR CHILD HAVE ANY PHYSICAL CONDITIONS THAT MAY AFFECT MOVEMENT DURING CLASS? (E.G HIP DYSPLASIA, RECENT SURGERY AND/OR INJURY)
MY CHILD DOES NOT SUFFER FROM ANY OF THE ABOVE
IF YOU ANSWERED YES TO ANY OF THE ABOVE, PLEASE PROVIDE DETAILS:
DUE TO GOVERNMENT HEALTH POLICIES, WE ARE LEGALLY UNABLE TO PROVIDE FIRST AID TO A STUDENT WITHOUT PARENTAL/GUARDIAN CONSENT. THIS INCLUDES, BUT IS NOT LIMITED TO ADMINISTERING PANADOL & BAND AIDS.
IN THE UNLIKELY EVENT OF AN INCIDENT, DO YOU GIVE PERMISSION FOR YOUR CHILD TO RECEIVE FIRST AID FROM A TRAINED FIRST AID STAFF MEMBER?
YES
NO
DOES YOUR CHILD HAVE A PARACETAMOL ALLERGY?
YES
NO
DO YOU GIVE PERMISSION FOR A STAFF MEMBER TO CALL AN AMBULANCE IN THE UNLIKELY EVENT OF A SERIOUS INCIDENT?
YES
NO
DO YOU HAVE AMBULANCE MEMBERSHIP?
YES
NO
IF YES, PLEASE PROVIDE YOUR MEMBERSHIP NUMBER:
By signing below, I acknowledge that the above information is true & correct. The Rage Dance Company cannot be held responsible for actions taken to provide medical attention that is not listed above.I understand that this information will be kept confidential by The Rage Dance Company staff members & will only be given to my child’s teachers/staff.
SIGNED
FULL NAME
First Name
Last Name
FEES
*PLEASE SELECT YES AT EACH POINT IN ACKNOWLEDGEMENT*
A non-refundable $40.00 enrolment fee per family is to be paid annually on enrolment.
YES
Fees are due 1 week PRIOR to the start of each Term, except for Term 1, when they are due by Week 2. This is only applicable for term payments
YES
NO refunds or credits will be given for missed classes. This includes extended holidays.
YES
Payment of fees must be strictly adhered to. A late fee of 5% for term payments & $10.00 for all other options, will occur if payment is unsuccessful and/or not made. This will be applied if payment is more then 3 days late & applied weekly after that
YES
Students with unpaid fees of 7 days or more will be asked to sit out of classes. If fees remain unpaid by the end of the term, the student will be unable to commence the next term until fees are paid.
YES
Fees that are more than 14 days overdue may be referred for further collection activity.
YES
Fees are to be paid via invoice, cash or direct transfer
YES
Fees can be paid with the option of weekly, fortnightly or per term payments.
YES
SIGNED
FULL NAME
First Name
Last Name
MEDIA RELEASE
I give permission for my childs image/video to be used for social media purposes such as, but not limited to facebook, instagram, twitter and/or youtube, for a period of up to 2 years.
YES
NO
Do you give permission to tag?
Yes
No
If yes, please list the username & platform (Instagram, Facebook, TikTok etc.)
I acknowledge the above information is true & correct & I understand that I am agreeing to any conditions listed above. I understand that The Rage Dance Company must be made aware of changes to any of the social media details I have provided above and that I can remove permission in writing to info@theragedc.com at any time
SIGNED
FULL NAME
First Name
Last Name
CLASSES ENROLLING IN:
PETITE CLASSES ($12 PER CLASS, PER WEEK)
BALLET (MONDAY 4:00 - 4:30PM)
JAZZ (MONDAY 4:30 - 5:00PM)
LYRICAL (MONDAY 4:00 - 4:30PM)
HIP HOP (WEDNESDAY 4:00 - 4:30PM)
ACROBATICS (WEDNESDAY 4:30 - 5:00PM)
TAP (WEDNESDAY 5:00 - 5:30PM)
BALLET (SATURDAY 10:00 - 10:30AM)
JAZZ (SATURDAY 10:30 - 11:00AM)
LYRICAL (SATURDAY 11:00 - 11:30AM)
MINI CLASSES ($12 PER CLASS, PER WEEK)
LYRICAL (MONDAY 4:00 - 4:30PM)
BALLET (MONDAY 4:30 - 5:00PM)
JAZZ (MONDAY 4:00 - 4:30PM)
TAP (WEDNESDAY 4:00 - 4:30PM)
HIP HOP (WEDNESDAY 4:30 - 5:00PM)
ACROBATICS (WEDNESDAY 5:00 - 5:30PM)
LYRICAL (SATURDAY 10:00 - 10:30AM)
BALLET (SATURDAY 10:30 - 11:00AM)
JAZZ (SATURDAY 11:00 - 11:30AM)
JUNIOR CLASSES ($14 PER CLASS, PER WEEK)
BALLET (MONDAY 4:30 - 5:15PM)
JAZZ (MONDAY 5:15 - 6:30PM)
LYRICAL (MONDAY 6:30 - 7:15PM)
TAP (WEDNESDAY 4:30 - 5:15PM)
HIP HOP (WEDNESDAY 5:15 - 6:30PM)
ACROBATICS (WEDNESDAY 6:30 - 7:15PM)
JAZZ (SATURDAY 11:00 - 11:45AM)
BALLET (SATURDAY 11:45 - 12:30PM)
LYRICAL (SATURDAY 12:45 - 1:30PM)
PRE-TEEN CLASSES ($14 PER CLASS, PER WEEK)
BALLET (MONDAY 5:15 - 6:00PM)
JAZZ (MONDAY 6:00 - 6:45PM)
LYRICAL/CONTEMPORARY (MONDAY 6:45 - 7:30PM)
TAP (WEDNESDAY 5:15 - 6:00PM)
ACROBATICS (WEDNESDAY 6:00 - 6:45PM)
HIP HOP (WEDNESDAY 6:45 - 7:30PM)
TEEN CLASSES ($16 PER CLASS, PER WEEK)
TAP (TUESDAY 5:00 - 6:00PM)
ACROBATICS (TUESDAY 6:00 - 7:00PM)
CONDITIONING (SATURDAY 10:30 - 11:00AM)
LYRICAL/CONTEMPORARY (SATURDAY 11:45 - 12:45PM)
BALLET (SATURDAY 1:00 - 2:00PM)
JAZZ (SATURDAY 2:00 - 3:00PM)
HIP HOP (SATURDAY 3:00 - 4:00PM)
INTERMEDIATE CLASSES ($16 PER CLASS, PER WEEK)
TAP (TUESDAY 5:00 - 6:00PM)
ACROBATICS (TUESDAY 6:00 - 7:00PM)
CONDITIONING (SATURDAY 10:30 - 11:00AM)
BALLET (SATURDAY 11:45 - 12:45PM)
HIP HOP (SATURDAY 1:00 - 2:00PM)
JAZZ (SATURDAY 2:00 - 3:00PM)
LYRICAL/CONTEMPORARY (SATURDAY 3:00 - 4:00PM)
SENIOR CLASSES ($16 PER CLASS, PER WEEK)
TAP (TUESDAY 5:00 - 6:00PM)
ACROBATICS (TUESDAY 6:00 - 7:00PM)
CONDITIONING (SATURDAY 10:30 - 11:00AM)
JAZZ (SATURDAY 11:45 - 12:45PM)
LYRICAL/CONTEMPORARY (SATURDAY 1:00 - 2:00PM)
HIP HOP (SATURDAY 2:00 - 3:00PM)
BALLET (SATURDAY 3:00 - 4:00PM)
ANY OTHER COMMENTS FOR ENROLLMENT IF REQUIRED:
FEE PAYMENT
PAYMENT OPTIONS: (PLEASE SELECT PREFERRED)
PER TERM VIA INVOICE LINK
PER TERM VIA DIRECT DEBIT/CARD PAYMENT DEBITED THE FRIDAY BEFORE TERM START
WEEKLY DIRECT DEBIT/CARD PAYMENT *Debits every Friday
FORTNIGHTLY DIRECT DEBIT/CARD PAYMENT *Debits every second Friday
I understand there is a non-refundable $40.00 enrolment fee that must be paid to secure my enrolment
YES
By signing below I acknowledge that I agree to pay as per the requested time frame of either per term, weekly or fortnightly by The Rage Dance Company.
YES
I understand that costume payments if required are not included in the price of the fees listed above
YES
I understand that I will incur a late fee of 5% for term payments & $10.00 for all other options, if my payment is unsuccessful. This will be applied if payment is more then 3 days late & applied weekly after that. I understand if payment is more than 7 days late, my child will not be able to partake in class until fees are paid & no credits are refunds are given in this instance
YES
I understand that I will not receive refunds for missed classes on my behalf & that I am liable to the fees as per the rules & regulations of The Rage Dance Company if I terminate classes prior to the term or year end. I understand that I will be entitled to receive a credit or refund, whichever is most applicable for any classes missed due to COVID-19
YES
I understand & agree to the rules & regulations of The Rage Dance Company. I understand these can be found at The Rage Dance Company website; www.theragedc.com
YES
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ENROLLMENT FEE
$
40.00
AUD
Credit Card
BY SIGNING BELOW I AGREE TO CONFIRM MY CHILD'S ENROLLMENT AT THE RAGE DANCE COMPANY & THAT ALL DETAILS ARE TRUE & CORRECT. I UNDERSTAND THAT MY CHILD'S ENROLLMENT IS VALID UNTIL JANUARY 15 2023 UNLESS TERMINATED PRIOR. ANY AMENDED INFORMATION PROVIDED UNTIL THIS TIME WILL BE VALID UNTIL THE SAME DATE.
SIGNED
FULL NAME
First Name
Last Name
DATE
-
Month
-
Day
Year
Date
Submit
Should be Empty: