Dance Central Enrolment

Enrolment Form
Child's Name*

First NameMiddle NameLast Name
Child's Birth Date*

DayMonthYear
Gender*

FemaleMale
Parent/Legal Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState/Province

Postal / Zip CodeCountry
2nd Parent/Caregiver*

First NameLast Name
Phone Number

Area CodePhone Number
Emergency Contact (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Siblings at Dance Central*
(Yes or No)
Junior Class Choices

Pre School Fairies (3-4 yrs) Risingholme Tue 1-1.30pmFairytale Ballet (4-5 yrs) Huntsbury Sat 9-9.30am (limited Space)Pre Primary Ballet (6-7 yrs) Risingholme Tue 4-5pmPrimary (5-6 yrs) Huntsbury Sat 9.30-10.15amJunior Ballet Academy 1 (8-9 yrs) Fri&SatJunior Ballet Academy 2 (9-10 yrs) Fri&SatJunior Ballet Academy 3 (10-12 yrs) Fri&SatGrade 5 Ballet (10-12 yrs) TueContemporary/Lyrical (9-12yrs) TueMini Modern/Acro (5-7yrs) ThursJunior Modern (7-11yrs) ThursJunior Acro (7-11) ThursJunior Musical Theatre (7-11) ThursJunior Modern Program (please inquire)Dance Central Extend
Senior Class Choices

Intermediate Foundation Ballet (11+yrs)Intermediate Ballet (11+yrs)Open Ballet Class (11+yrs)Open Contemporary (11+yrs) WedMusical TheatreNZAMD Elementary Jazz (12+yrs)Adult BalletSenior Ballet & Modern Program - Please inquireDance Central Extend
Dance History (if any)
Medical or other information we may need to know about the child (including food allergies).*
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by Dance Central in printed and/or electronic media, for the purpose of promoting events, advertising and general information and on platforms such as website, facebook, instagram.*

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Enrolment Form

Media Release