Registration Form

Beyond the Barre Dance Academy Registration

Term 2
Dancers Information
Dancer's Name

First NameLast Name
Birth date

DayMonthYear
Gender

MaleFemaleOther
Current age group

18 months - 2 yrs2- 4 yrs4-6 yrs6-8 yrs8-12 yrs12-16 yrs16yrs+Other
Date

MonthDayYear
Date
School
Parent/Guardian Information (if dancer is under 18)
Name

First NameLast Name
Mobile Number

eg 021Phone Number
E-mail
example@example.com
Alternative Emergency Contact
Emergency Contact's Name

First NameLast Name
Mobile Number

eg 021Phone Number
Does the dancer have asthma, allergies, or any other medical condition? If yes, please describe.
Membership
Program

Tutu's & Tiara's - Pre BalletPre- Junior Program (ages 4- 6)Recreational ProgramAcademy Vocational schoolKleine lyfieKings & QueensEpic KidsAdults
Payment option

Online payment - please request internet banking details
Acknowledgement I understand that all sports carry a risk of injury and that Beyond the Barre dance academy is not responsible for injuries or loss suffered as the result of participating in these activities. From time to time Beyond the Barre dance academy will post photographs of our dancers, coaches, and supporters online. I will let Beyond the barre know by email if I do not consent to my or my child’s photos being shared. Beyond the barre will give 30 days written notice of any fee increase.
Medical Authorization In the event of an injury or medical emergency, I allow Beyond the barre dance academy to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the dancer named above. I understand that all reasonable efforts will be made to contact the dancer’s parent and/or emergency contact if an injury or medical emergency occurs.
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Beyond the Barre Dance Academy Registration