WAPA Enrolment Form

WAPA Enrolment Form

Please fill out the following enrolment form to enrol for class at WAPA
Students Name*

First NameLast Name
Students Date of Birth*

MonthDayYear
Date
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Emergency Contact Relation to Student*
Address

Street Address

Street Address Line 2

CityCountry

Postal / Zip Code
Classes Wishing to Enrol ($10 per class)*

Junior HIP HOP (Mondays 4.15pm - 5.00pm) - Colette WilsonJunior Contempary Mondays 5.00pm - 5.45pm) - Colette WilsonSenior Hip Hop (Mondays 5.45pm - 6.30pm) - Colette WilsonSenior Jazz (Monday's 6.30pm- 7.15pm) - Colette WilsonJunior MUSICAL THEATRE(Friday's 5:00pm-6:00pm)-Colette WilsonSenior MUSICAL THEATRE(Friday's 6:00pm-7:00pm)-ColetteWilsoBaby Ballet age 3+Years ( Saturdays' 8.30-9am)Colette WilsonBaby Ballet Age 4-5 Years (Saturday's 9.00-9.30am)-Colette WilsonCOF Circle Of Friends 7+ Years (Tuesdays 4:30-6pm)-Colette WilsonAdult Hip Hop Fitness (Tuesday's 6-6:45pm)- Colette WilsonMini Hip Hop 4-6 Years (Monday's 3.30pm-4:15pm)- Colette Wilson
Email Address*
example@example.com
Please list any Medical Conditions or any Ongoing Injuries (N/A if needed)*
Please list any previous dance experience
I consent to WAPA using images and videos of said student for marketing, website and social media purposes*

YesNo
Enter the message as it's shown*
Email
example@example.com
Should be Empty: