Fusion Dance Arts Enrollment 2026

Student's Name

First NameLast Name

Birthdate

Date

Age turning in 2026

Parent 1 / Guardian Name

First NameLast Name

Parent 2 / Guardian Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone / Mobile Number

Address

Street Address

Street Address Line 2

CityState

Post Code

Classes enrolling in:

Please list any allergies or medical conditions your child has that we need to be aware of

In light of government health policies, we are legally unable to administer first aide without parental consent. However, it is our duty of care to apply first aide where needed. In the event of an injury or accident, would you like your child to receive first aide?

If an ambulance needs to be called, would you like us to do so?

Signature Required: I have read all information contained in the enrollment pack and enrol my child understanding and abiding by all terms, conditions and information outlined in this.

Please read carefully before signing below:
Participation in any Fusion Dance & Fitness (now know as Fusion Dance Arts) activity and use of any recreational facilities involves a risk of accidental injury despite all safety precautions.
Having been informed of the activities conducted by Fusion Dance & Fitness, I / we, as an individual or as a parent or guardian of the participants named herein, assume all risks and hazards incidental to the activities, and release from responsibility and agree to indemnify and hold harmless Fusion Dance & Fitness, its officers, directors, independent contractors, volunteers and all employees for any illness or injury to me or my children or family members occurring during his / her / our participation in any activity or use of any recreational facility at or conducted by Fusion Dance & Fitness.

Note: Signature is required as a condition of enrolment.

Signature

I, the undersigned, do hereby grant or deny permission to Fusion Dance Arts to use images of my child, as marked by my selection(s) below.

Signature

FUSION DANCE ARTS

Insurance Waiver & Consent Agreement

Media Release