Dance Classes Registration

Date of birth

Date

Gender

Name

First NameLast Name

Parent/Guardian Name (if student under 18 years of age)

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: 0000 000 000.

Address

Street Address

Street Address Line 2

CityState

Emergency Contact Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: 0000 000 000.

Dance Class of Interest

Level of Experience

Preferred Class/Lesson Day

Preferred Class/Lesson Time

Please disclose any medical conditions, allergies, or physical limitations that the studio should be aware of to ensure your safety.

How did you hear about us?

Terms and Conditions:

By submitting this form, I acknowledge that participation in dance classes involves physical activity and I hereby release the dance studio and its instructors from any liability for injuries or accidents that may occur during classes or events.

I understand and agree to abide by the studio's policies, including attendance, fees, and conduct.

I authorize Ballroom Blitz Dance Studio Bundaberg to use any photos/videos taken during classes for promotional purposes unless otherwise requested in writing.

I acknowledge that any fees paid are non-refundable.

Date accepted

Date