UNDER 12s KBC EXTENDED ASSOCIATE PROGRAMME Registration Form

KBC EXTENDED PROGRAMME!

Thank you for registering your interest in the KBC EXTENDED ASSOCIATE PROGRAMME! This form is for UNDER 12s PRICING: £105 Termly Fee (This covers 3 monthly sessions) Please fill out this form to apply for a place in the programme. Along with this form please email over your self tapes to our email: katiebracecreatives@gmail.com You MUST have permission from your dance school.
January start Term Dates

25th Jan

22nd feb

29th March
Participant Name

First NameLast Name
Participant Information
Birth Date

MonthDayYear
Parent/Guardian Information
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the participant prescribed an inhaler? If yes, please explain any instructions.
We agree to provide the following :

*A professional service.
*High quality workshops.
*Appropriately experienced staff with the necessary checks, qualifications and insurance.
*A safe and friendly environment for learning.

In return for this commitment to you, we ask that you agree to our terms and conditions before your book one of our programmes. Please contact us at: katiebracecreatives@gmail.com if you have any questions before agreeing to the following terms and conditions.
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.
Date

MonthDayYear
Date
Signature
Should be Empty:

KBC EXTENDED PROGRAMME!

Participant Information