Battu Brisé Adults Registration Form

Student Registration Form

Please fill out the following fields to complete the registration process
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Students Identity Number *
South African I.D. number or Passport Number
Previous Teacher / Gym
Gender
Starting Date

MonthDayYear
Date
Student E-mail
example@example.com
Students Mobile Number
Phone Number
Work Number
Emergency Contact Details
Please select your group class you will be attending

BalletBody ConditioningCheezee Fitness (Aerobics)Pilates

Please select the class card you will use

Class Card 1 - 1 Class each weekClass Card 2 - 2 Classes each weekClass Card 3 - 3 Classes each weekClass Card 4 - Unlimited classes each week
Medical Information

Allergies, Chronic conditions, etc --Please provide details in the comments section below , please include any chronic medication that needs to be with the student at all time (EpiPen, asthma pump etc)
Comment Section

Person Responsible for the account
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
Phone Number
Please enter a valid phone number.
Work Phone number
Please enter a valid phone number.
Alternative Contact for Account *
Please enter a valid phone number. Please provide the details below for an alternative person responsible for the account
Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Battu Brisé PTY LTD's Protocols (Terms and Conditions) can be found on our website. (https://battubrise.com/?page_id=740)

Should you have an questions or require more information, please do not hesitate to contact us.

There is an annual registration fee per family.

Dance Items such as bags, leotards, skirts and studio merchandise can be purchaded directly through the studio.

Visit our websit for more information

Uniform and Equipment

Ballet Clothing and shoes can be found in our dance shop.
* Please note for our Ballet classes the Royal Academy of Dance goes according to age and not according to school grade *

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.
Signature*

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Student Registration Form