Dance Classes Registration

Please make a selection

Date Started

Date

Dancers Name

First NameLast Name

Gender

Date of birth

Date

Age

School

Grade & Class

GradeClass

Medical Conditions or Allergies

Parent/Guardian 1 Responsible for the Account

First NameLast Name

Parent 1 ID Number

Parent 1 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email 1

example@example.com

Name of employer

Parent/Guardian Name 2

First NameLast Name

Parent 2 ID Number

Parent 2 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent 2 Email

example@example.com

Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of Relative Not Living With You

First NameLast Name

Relationship to Student

Relative Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Are you happy for your child to appear in the media? eg. Facebook / Instagram etc.

How did you hear about us?

Terms and Conditions:

By submitting this form, I acknowledge that participation in dance classes involves physical activity and I hereby release DANCE MOUSE COMPANY and its instructors from any liability for injuries or accidents that may occur during classes or events.

I understand that the cancelation of my child's classes is subject to a one month written notice.

I understand that should a child be unable to attend a lesson for whatsoever reason e.g. absence / school events, the lesson will be forfeited.

There will be no lessons on Public Holidays.

I undertake to pay my fees in advance before the 7th of each month and understand that my child will receive no lessons until such payment has been made.

I undertake to pay my fees in full each month of enrollment until and including the month of November.

Date signed

Date

Type a question

Dance Classes Registration Form