Dance Registration Form

REGISTRATION FORM

LCM DANCE ACADEMY
Students Name*

First NameLast Name
Students Gender*

FemaleMale
Date of Birth*

MonthDayYear
Date
Students Age*
1) Parent / Guardian Name*

First NameLast Name
1) Contact Number*
Emergency Contact Number*
E-mail*
2) Parent / Guardian Name

First NameLast Name
2) Contact Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please Select Class of Interest*

Wednesday (4:00-4:30pm) Pre-School BalletWednesday (4:30-5:00pm) Pre-Primary BalletWednesday (5:00-5:30pm) Junior Acro Dance (ages 4+)Wednesday (5:30-6:15pm) Inter Acro DanceThursday (5:00-5:45pm) Junior JazzThursday (6:30-7:30pm) Beginners Adult BalletSaturday (8:30-9:00am) Baby BalletSaturday (9:00-9:30am) Pre-School BalletSaturday (10:00-10:45am) Primary BalletSaturday (10:45-11:30am) Grade 1 BalletSaturday (9:30-10:00am) Pre-Primary BalletThursday (5:45-6:30pm) Advanced Acro danceMonday (5:45-6:30pm) Junior PBT programMonday (6:30-7:30pm) Adult PBT programPrivate coaching enquiryOther
Do you give consent for your child to be photographed/filmed for advertisement of the school*

YesNo
How did you hear about us:*
Previous Dance School?
Does your child have any Previous Dance Experience?
Does your child have any Medical Conditions, Allergies or Injuries we should know about?
Any further comments
Declaration*

I accept the LCM Dance Academy Terms & Conditions, Privacy Policy & Safeguarding Policy.
Please verify that you are human*
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REGISTRATION FORM