SJB - Dance Class Enrolment & Participation Consent Form

SJB - Dance Class Enrolment & Participation Consent Form

Please fill out this form to provide your consent for participation in the dance class.
Participant's Full Name

First NameLast Name
Year
Date of Birth

DayMonthYear
Date
Parent/Guardian Full Name (if participant is under 18)

First NameLast Name
Parent's Email
example@example.com
Emergency Contact Number
Please enter a valid phone number.Format: (0000) 000-000.
Does your child have any medical conditions or allergies we should be aware of that may effect his/her dance practise?
If Yes to above question please list any medical conditions or allergies your child has.
If Yes - Please list medical conditions or allergies.
Signature of Participant or Parent/Guardian
Date of Signature

DayMonthYear
Date
DANCE FEES for Shortened Term 3

1 Dance Class a week = $60/term

Bank Details for Direct Deposits

Account Name : Creative Pulse

BSB no : 062 127

Account no : 1010 6381
Reference : Your Childs name - DanceT3
Should be Empty: