Disco Duck Term 1 Registration

Term 1 Registration Form

OUT TO PLAY - September 8th & September 10th to October 13th & October 15th
Child's Information
Name of Child

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Age in Term
Parent/Guardian Information
Name

First NameLast Name
Contact Number
Email Address
example@example.com
Emergency Contact

If Different From Above
Name

First NameLast Name
Relationship to Child
Contact Number
Medical Information
Does your child have any allergies or medical conditions we should be awareof? If yes, please specify
Desired Class Day
Desired Payment Option
Parent/Guardian Agreement
I hereby give permission for my child to participate inthe Disco Duck class. I understand the importance of safe dance practice and will ensure clothing and accessories are appropriate for the active nature of the Disco Duck Classes.
Disclaimer
I understand the Disco Duck programme is payable in line with the option I have chosen above that will be confirmed in email communication by the Teacher. Failure to do so will result in refusal of attendance by the Teacher.
Media Consent
I understand my Disco Duck teacher will take photos and short videos of the class attendees for further social media marketing and social media celebrations. Please select YES below to consent and NO to opt out
Should be Empty:

Term 1 Registration Form