Student Enrolment Form
GYPSY GYM
Name:
*
First Name
Last Name
Type of enrolment:
Family Enrolment
Individual Enrolment
$20 trial class
Birthday:
*
-
Month
-
Day
Year
Date
Email:
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Number:
*
Please enter a valid phone number.
Please choose which class/classes you would like to join:
*
Gypsy Gym Wednesday 10-11 am Windale
Gypsy Gym Wednesday 6:30-7:30 pm Mayfield
Gypsy Gym Thursday 9:30-10:30 am Hamilton
Gypsy Gym Monday Swansea 6:30-7:30pm
How did you hear about 'Newcastle Flamenco Dance' and 'Gypsy Gym'?
Do you give 'Newcastle Flamenco Dance' permission for the student to be photographed and videoed for promotional purposes?
Yes
No
Sign up to receive updates about new classes, workshops & performances:
Yes
No, thanks
Signature:
Submit
Should be Empty: