Brolga Dance Academy
Student Registration Form 2025 - on Gadigal Land in Redfern
Student Details
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Age
*
Aboriginal or Torres Strait Islander Tribes/Clans
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student's Mobile Number
Please select the Dance Classes you wish to enroll.
*
Traditional - Open Class - 5+yrs to Adults
Aboriginal Contemporary Juniors (5-11yrs)
Aboriginal Contemporary Seniors (12+ years)
Aboriginal Cultural Dance (Adults, 18+ years)
Student's Email address
example@example.com
Does the student have any allergies?
*
No
Yes
If "Yes", please list along with medical treatment information (if required)
Does the student suffer from any medical conditions?
*
No
Yes
If "Yes", please list along with any medical treatment (if required)
Parent/Guardian Details
Primary Career/ Parent Guardian One
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Number
Email
example@example.com
Parent/Guardian
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Number
Email
example@example.com
Emergency Contact
In the result of an emergency and both parents can not be contacted please list an emergency contact.
Name
*
First Name
Last Name
Relationship to Student?
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Number
Email
*
example@example.com
Authorisations
In the case of an emergency I give permission to the Brolga Dance Academy employees and sub-contractors to arrange any medical care (including an ambulance) and the administration of treatment in the case an emergency contact and/or parents/guardians can not be contacted at the cost of the parent/guardian.
*
Yes
No
I give permission for the publication of images and video content of the Student's participation in the Brolga Dance Academy classes, performances and all relevant activities on BDA'S social media platforms, website and all marketing and promotional material.
*
Yes
No
Declaration
We, the undersigned parents/guandians and/or students, hereby acknowledge that we understand and accept that there are fees associated with the dance classes provided at Brolga Dance Academy. We recognize that these fees are necessary for the operational costs of the studio, including instruction, facilities, and supplies. We understand that timely payment of these fees is essential to ensure our child’s continued participation in the class. We agree to make all required payments by the stipulated deadlines and understand that failure to do so may result in our child or students being unable to continue in the class. By signing below, we confirm our understanding and acceptance of these terms.
Yes
No
Name
First Name
Last Name
Signature
Date
-
Day
-
Month
Year
Date
Thank You!
We look forward to having you join the Brolga Dance Academy family.
Submit
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