Fairy Dust

Dancer Full Name*

First NameLast Name

Parent/Gaurdian Full Name*

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Which class is your child enrolled/enroling for?

How did you hear about us?

MEDICAL WAIVER

By signing this waiver, I, the legal guardian of the student(s) I have registered for FDD, agree to the following conditions:

I authorize FDD to contact the persons named as parents or emergency contacts and to authorize the named physician to render such treatment to my child as deemed necessary. I understand that FDD is not covered to give my child any controlled medicine and I will make arrangements for my child to be given this by a parent or gaurdian.

Further, this signed statement certifies that my child is medically cleared to participate in the FDD timetable and to participate in all classes described.

Clicking the box below confirms that you have read the medical waiver, that you understand it, and that you agree to be bound by it.

Name of Parent/Guardian that agrees and adhere to medical waiver

First NameLast Name

Health History

Rows	No	Yes	Please Explain.
Does your child have any restrictions on activity?
Will your child need any special assistance while in class?
Is there there anything else you feel we should know health wise about your child? Please list any other medical information or past injuries FDD should know about your child.

Medical Questions

Rows	No	Yes	If yes, please explain.
Does your student have any allergies?
Does your student require an EpiPen?
Does your student have any dietary restrictions?

By signing Parent/Gaurdian name I agree and will make sure my child agrees to all terms & conditions stated on this form. Once signed please message to ask for BACS for your child’s £10 enrolment fee to be paid (usual monthly fee account for returning pupils)