Student Registration Form

Dance Street Student Registration

Please ensure each question is completed
STUDENT DETAILS
STUDENT NAME

First NameLast Name
STUDENT DATE OF BIRTH

DayMonthYear
STUDENT GENDER
SPECIAL NEEDS / ALLERGIES

Other
*Please upload Medical Management Plan here

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PARENT DETAILS
Parent Details

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile number 1
Mobile number 2
E-mail address 1
E-mail address 2
example@example.com
BUNDOORA CLASS SELECTION
BUNDOORA CLASS SELECTION*
LALOR CLASS SELECTION
LALOR CLASS SELECTION*
List which class day(s) you prefer - (see full timetable on our website)
*Class selection will be confirmed, as class age groups are based on age and ability. The age limits are a guide only and class entrance is up to the discretion of the instructor based on both of these factors.
Consent to photography and video images being used on our website and social media
I agree that I will not photograph or publish images of other students at the service without the express consent of the teacher in charge
I accept that all fees paid are non-refundable
How did you hear about Dance Street?

Other
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Dance Street Student Registration