Enrol Now — ELEVATEdance

To enrol in classes for 2018, please complete the Enrolment Form below.

STUDENT INFORMATION

Student's Name *

Student's Name

First Name

Last Name

Student's Date of Birth (DD/MM/YYYY) *

Year at School in 2018 *

Student's Status *

IF STUDENT IS UNDER 18 PLEASE FILL IN THE CONTACT INFORMATION FIELDS WITH PARENT/GUARDIAN DETAILS

Parent/Guardian Name

If student is under 18

First Name

Last Name

Email Address *

Cell Phone Number *

Address *

Student's Medical Details

Please let us know about any medical conditions/learning difficulties that we need to be aware of.

Student's Previous Dance Experience

EMERGENCY CONTACT (different to Parent/Guardian above)

Emergency Contact Name *

Emergency Contact Name

First Name

Last Name

Emergency Contact Cell Phone Number *

Relationship to Student *

CLASSES ENROLLING IN FOR 2018

Please select the classes you are enrolling in from the drop down boxes below. Class Descriptions are found on the Hip Hop, Jazz, Contemporary and Open Class Pages on this Website.

1st Class *

2nd Class

3rd Class

4th Class

Terms of Enrolment *

By ticking the box below you understand and agree to the Terms of Enrolment stated here in the Policy Agreement and Informed Consent. (Parent/Guardian to agree if student is under 18).

I Agree