2022 ENROLLMENT FORM

2022 ENROLLMENT FORM

EPPING
STUDENT DETAILS
STUDENT NAME

First NameLast Name
STUDENT D.O.B

MonthDayYear
Date
STUDENT CONTACT NUMBER (IF APPLICABLE)

Area CodePhone Number
STUDENT EMAIL (IF APPLICABLE)
example@example.com
STUDENT ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARENT DETAILS
PARENT 1 NAME

First NameLast Name
PARENT 1 PHONE NUMBER

Area CodePhone Number
PARENT 1 EMAIL
example@example.com
PARENT 2 NAME

First NameLast Name
PARENT 2 PHONE NUMBER

Area CodePhone 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 NameLast Name
CONTACT 1 PHONE

Area CodePhone Number
RELATIONSHIP TO STUDENT
CONTACT 2 NAME

First NameLast Name
CONTACT 2 PHONE

Area CodePhone Number
RELATIONSHIP TO STUDENT
SIGNED
FULL NAME

First NameLast 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)
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?
DOES YOUR CHILD HAVE A PARACETAMOL ALLERGY?
DO YOU GIVE PERMISSION FOR A STAFF MEMBER TO CALL AN AMBULANCE IN THE UNLIKELY EVENT OF A SERIOUS INCIDENT?
DO YOU HAVE AMBULANCE MEMBERSHIP?
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 NameLast 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.
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
NO refunds or credits will be given for missed classes. This includes extended holidays.
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
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.
Fees that are more than 14 days overdue may be referred for further collection activity.
Fees are to be paid via invoice, cash or direct transfer
Fees can be paid with the option of weekly, fortnightly or per term payments.
SIGNED
FULL NAME

First NameLast 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.
Do you give permission to tag?
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 NameLast Name
CLASSES ENROLLING IN:
PETITE CLASSES ($12 PER CLASS, PER WEEK)
MINI CLASSES ($12 PER CLASS, PER WEEK)
JUNIOR CLASSES ($14 PER CLASS, PER WEEK)
PRE-TEEN CLASSES ($14 PER CLASS, PER WEEK)
TEEN CLASSES ($16 PER CLASS, PER WEEK)
INTERMEDIATE CLASSES ($16 PER CLASS, PER WEEK)
SENIOR CLASSES ($16 PER CLASS, PER WEEK)
ANY OTHER COMMENTS FOR ENROLLMENT IF REQUIRED:
FEE PAYMENT
PAYMENT OPTIONS: (PLEASE SELECT PREFERRED)
I understand there is a non-refundable $40.00 enrolment fee that must be paid to secure my enrolment
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.
I understand that costume payments if required are not included in the price of the fees listed above
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
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
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

ENROLLMENT FEE

$40.00 AUD

Enter coupon

Total

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 NameLast Name
DATE

MonthDayYear
Date
Should be Empty:

2022 ENROLLMENT FORM

STUDENT DETAILS

PARENT DETAILS

EMERGENCY CONTACT (IN CASE OF EMERGENCY PICK-UP)

MEDICAL HISTORY

FEES

MEDIA RELEASE

CLASSES ENROLLING IN:

FEE PAYMENT

Credit Card