2022 Enrolment Form for New Students

2022 Enrolment Form for New Students
1st Student's Name:*

First Name Last Name
1st Student Date of Birth:*

DayMonth Year
Date
2nd Additional Student Name

First Name Last Name
2nd Additional Student Date of Birth:

DayMonth Year
Date
3rd Additional Student Name

First Name Last Name
3rd Additional Student Date of Birth:

DayMonth Year
Date
Residential and Postal Address:*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent Mobile No:*
Phone Number
Parent Email:*
example@example.com
How did you hear about us?*
Medical Details & Individual Needs
Doctor's Name:*
Doctor's Phone No:*
Students Medicare No:*
Do you have ambulance cover?*

YesNo
It is essential that you tell us before your child starts classes if they have any allergies, medical conditions or injuries. You should also let the class teacher know as soon as you are aware of any allergies, medical conditions or injuries so we can update our records for in the case of an emergency.
Allergies/Medical Conditions:*
Parent/Guardian Details

Primary Carer
Parent/ Guardian Name:*

First Name Last Name
Parent/Guardian Relationship to Student:*
Parent/Guardian Mobile Phone No/s:*
Parent/Guardian Email/s:*
example@example.com
Emergency Contact Details

Different from Primary Parent/Guardian details
Emergency Contact Name:*

First Name Last Name
Emergency Contact Phone No:*
Emergency Contact Relationship to Student:*
Signatures

All parents/guardians to sign for students under 18yrs of age
1. I / we agree that we have received a copy of the 2022 Enrollment Package, Terms & Conditions and we agree upon all aspects outlined in these documents.

2. I / we acknowledge that acceptance of a place signifies agreement to support all policies and guidelines covering Hunter Urban Dance Studio, its staff, students and voluneteers.

3. I / we agree to promptly pay all fees, levies and charges incurred while my child is enrolled.

4. I / we acknowledge all details supplied on this form are full and accurate and I / we agree to advise Hunter Urban Dance Studio and its staff of any change to these details.

5. I / we have read and understood the enrollment terms and conditions.
Signature:*

Clear
Date:*

DayMonth Year
Date
PUBLICITY RELEASE

I here-by give permission to Hunter Urban Dance Studio to take photographs, film or videos of my child for the exclusive use of PPSD. I consent to the use of such materials and/or the use of my child's name for PPSD's promotional purposes such as marketing brochures, flyers, video and website by Hunter Urban Dance Studio.
Signature:*

Clear
Date*

DayMonth Year
Date
2022 Timetables and Class Selections
For timetable details please contact admin@hunterurbandancestudio.com and we can help you find the right for you / your child.

For all private lesson bookings, contact us on admin@hunterurbandancestudio.com to book in an available spot. These are first in best dressed.
Please indicate which day and classes you/your child will be enrolling in (ensure you state the age group):*
eg Junior Jazz Tuesdays 4pm
Class Payment Options

There is an option to pay via direct debit (which we can set up for you) or via term/session invoice. Please note that direct debit payments must remain 3 weeks ahead and term invoice payments must be made prior to the start of the term/session. If selecting direct debit we will send you a direct debit authorisation form to complete for payments to start as early as you like them to (January 15 for all others to minimise any upfront payment required to ensure all fees are set up 3 weeks in advance).
Please select which payment option works for you:*

Direct Debit - weeklyDirect Debit - fortnightlyDirect Debit - monthlyInvoice - Full Payment Due Upfront

My Products*

Recreational Student Enrolment for Individual - non refundableIndividual Enrollment Fee

$50.00AUD Quantity
Item subtotal:$0.00AUD

Additional Fee for FAMILY Member/s Enrollment - non refundableThis covers enrolment for all members of the one household.

$40.00AUD Quantity

Competition Registration FeeCompetitive Dance and Cheer Teams

$15.00AUD Quantity

Total

$0.00AUD

Credit Card

Should be Empty:

2022 Enrolment Form for New Students

Medical Details & Individual Needs

Parent/Guardian Details

Emergency Contact Details

Signatures

2022 Timetables and Class Selections

Class Payment Options

Credit Card