Dance for Girls
Tuesdays 4.30-6pm - Age 9-15
Name of young person
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Non-Binary
Prefer not to say
Ethnicity
*
School attended, if applicable
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Parent/Carer
*
First Name
Last Name
Parent/carer email address
*
example@example.com
Parent/carer mobile number
*
EMPLOYMENT STATUS
*
Employed
Unemployed
Not allowed to work
DISABILITY Do you consider yourself to have any long-term disability, health problem or any learning difficulties?
*
Yes
No
Emergency Contact Name (This person will only be contacted if we cannot get hold of the parent/carer in an emergency)
*
First Name
Last Name
Relationship to the child (aunt, grandmother, family friend)
*
Emergency Contact Mobile Number
*
Does your child have any learning, behaviour, medical or mobility needs? Please let us know so we can best support your child in the dance sessions.
*
Does your child have any learning, behavioural, medical or mobility needs? Please let us know so we can best support your child in the dance sessions.
*
example@example.com
We will sometimes give out snacks and drinks. Does your child have any allergies?
*
Are you happy for your child to be photographed for Grand Junction's social media and website?
*
YES
NO
Have you been to Grand Junction before?
*
Yes
No
Do you want your email added to our mailing list?
*
Please Select
Yes
No
Has your child ever been to a dance class before?
*
Yes
No
Please sign here
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