2024 Enrolment Form

ExtravaDance 2024 Enrolment
Student 1*

First NameLast Name
Birthdate*

DayMonthYear
Date
School attended:
Student 2

First NameLast Name
Birthdate

DayMonthYear
Date
School attended:
Student 3

First NameLast Name
Birthdate

DayMonthYear
Date
School attended:
Medical conditions
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1
Phone Number

Area CodePhone Number
Email 1
example@example.com
Parent/Guardian 2
Phone Number

Area CodePhone Number
Email 2
example@example.com
Additional Emergency Contact - NOT PARENT (in the event that we cannot contact parents or guardian)*
Class selection

Please note class times may be subject to change
Port Macquarie Studio - Press/hold CTRL to select multiple classes
Wauchope Studio - Press/hold CTRL to select multiple classes

My Products

Enrolment fee (child 1)$47.50AUD

Enrolment fee (child 2)$44.50AUD

Enrolment fee (child 3)$40.00AUD

Total $0.00AUD

ExtravaDance 2024 Enrolment