Dance n' Beats
Enrolment Form
Student Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Guardian Name if Student is under 18
First Name
Last Name
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Studio
*
Please Select
Hayes
Langley
Slough
West Drayton
Private Lesson
Harrow
Subscription
*
£4.99 Uniform Fee + £35.00 Every 4 weeks (4 Weeks Pre Payment) - Direct Debit
£4.99 Uniform Fee + £94.50 Every 12 weeks (12 Weeks Pre Payment) - Direct Debit
Cippenham school Afterschool club Friday 3:30 pm (£6.50 a lesson)- Direct Debit
Cippenham school Bollywood Dance Saturday at 10:30am (£35.00 4 weeks)
Cippenham school Bollywood Dance Saturday at 10:30am (£94.50 12weeks)
Cippenham school Bhangra Dance Saturday at 11:30am (£35.00 4 weeks)
Cippenham school Bhanga Dance Saturday at 11:30am (£94.50 12weeks)
Western House Academy 7 weeks lesson after school club (£42.00)
Emergency Contact
*
Name
Number
If you have a Promo Code please enter it below
Signature
*
Submit
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