ENROLMENT FORM 2026

ENROLMENT FORM 2026

STUDENT INFORMATION
PARENT/GUARDIAN CONTACTS
Parent / Guardian 1 Details

First NameLast Name
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian 2 Details

First NameLast Name
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

INFORMATION WE NEED TO KNOW

ALLERGIES INJURIES, ILLNESS
Please explain any injuries, illness or allergies your child has and the action required.
Photographs

I give permission for Move & Groove with Chloe to use video footage and/or photographs of my child. This usage may include (but is not exclusive to) displaying publicly, distributing, or publishing, photographs, and/or video of my child for use in materials that include, but may not be limited to; printed material (brochures, programs and newsletter), online and offline advertising and promotion; videos and digital images such as use for social media.

By signing this form, I ackowledge that I am giving unrestricted permission for my child's images to be used in print, video and digital media. I agree that these images may be used without further notification. I do understand that any identifying information including surname and location will not be used in conjuction with any video or digitail images.
I agree to the above Photographs Permission Statement
Health Information & Waiver Form

I consent to my child participating in Move & Groove with Chloe classes and activities. I understand that every endeavour will be made to contact me prior to any medical attention being given. If it is not possible to contact me, I hereby authorise the Move & Grooev with Chloe team to seak medical attention (including treatment, emergency transport, hospitalisation, anaesthesia and medication) in the event of an accident mishap of illness during my child's participation in the classes throughout 2026.
I agree to the above 'Health Information & Waiver Form'
Payment of 2026 Fees

I understand that the enrolment fee of $5 per child and that all term fees are non-refundable and non-transferable. Payment will only be accepted via EFT or Internet Transfer. There will be a $20 late fee added to my account each week that my fees are overdue. I understand that my child may be refused from classes if fees are not up to date. (Note: payment plans are avilable however must be paid in the timeframe initially agreed upon).
I agree to the above 'Payment of 2026 Fees'
Parent / Guardian Name giving consent and agreeing upon above terms and conditions

First NameLast Name
Signature
Thank you for your enrolment for 2026!

We wil be in touch with your enrolment pack
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