Enquiry Form

1
Name of Parent/Guardian* This field is required.If student is under 18
First Name
Last Name
2
Phone Number* This field is required.
Area Code
Phone Number
3
Email* This field is required.
example@example.com
4
Name of Student* This field is required.
First Name
Last Name
5
Students Date of Birth* This field is required.
Date
Day
Month
Year
6
Which classes are you interested in?* This field is required.
7
Where did you hear about Pips Dance Academy?* This field is required.
Please Select
Please Select
Online
Word of mouth
School
Other
8
Please let us know which online platform, school or the name of the recommendation.* This field is required.
9
Please confirm you give permission for us to contact you via email about joining Pips Dance Academy and other useful information
Yes, please add me to your mailing list to receive information about joining Pips Dance Academy
Should be Empty: