Book a Trial Form 2026
Students Name
*
First Name
Last Name
DOB
*
-
Month
-
Day
Year
Date
Parents Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical Conditions (List and Advise of Plan)
How did you hear about us?
*
Friend or Family
Social Media
Google
Other
Have you danced before?
*
Yes (with Influence PA)
Yes (with another dance school)
No (Haven't danced beforr)
Haven't danced in a while
Ballet
Ready Set Ballet (Ages 2 - 5)
Pre Primary (Turning 5 or 6)
Primary (Turning 7)
Grade 1 (Turning 8)
Grade 2 (Turning 9)
Grade 3 (Turning 10)
Grade 4 (Turning 11)
Grade 5 (Turning 12)
Grade 6 (Turning 13)
Intermediate (Turning 14)
Advanced Foundation (Turning 15)
Advanced 1 (Turning 16 and above))
Which Level are you?
*
Pre School Program (Ages 2 - 5)
Petite Program (Turning 6 (or in Kindergarten) & 7)
Junior Program (Turning 8, 9 or 10)
Teen Program (Turning 11, 12, 13 or 14)
Senior Program (Turning 15 and above)
What styles would you like to take? (Petite - Senior ONLY) Please refer to the timetable on our website to help answer this question.
Kicks, Turns & Leaps (Junior - Senior ONLY)
Lyrical
Hip Hop
Ballet
Performance Team
Acrobatics
Beginner Pointe
Intermediate Pointe (At least 1 year of beginner pointe classes and own pointe shoes)
Advanced Pointe (At least 2 years on pointe)
Contemporary
Tap
Jazz
Musical Theatre
Pre School Program ONLY - What day would you like?
Tuesday (Ready Set Ballet & Dance 9:30 - 10:45am)
Friday (Ready Set Ballet & Dance 9:30am - 10:45am)
Saturday (Ready Set Ballet & Dance 10:30-11:15am)
Pre School Program ONLY - Ready Set Ballet (30mins)
Yes
No
Pre School Program ONLY - Ready Set Dance (45mins)
Yes
No
Date you would like to trial (if multiple days, pick the first day) Term 1 starts 27/1/2026
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Month
-
Day
Year
Date
Health and Safety - By agreeing you understand that although IPA takes all reasonable care in the conduct and safe dance of its classes that personal injury can occur and Influence PA and its staff will not be held responsible.
*
Agree
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