New Student Enrolment Student Information Student Name* First NameLast Name Date of Birth* -Day -MonthYearDate Picker Icon Is the Student under 18 or require permission from a parent or legal guardian* YesNo Address* Street Address Street Address Line 2 CityCounty Post Code Studio Classes Attending* Mini Street DanceJunior Street DanceIntermediate Street DanceSenior Street DanceIntermediate LyricalSenior LyricalIntermediate JazzSenior JazzPre Primary Ballet (Tuesdays)Pre Primary Ballet & Tap (Saturdays)Primary BalletGrade 1 BalletGrade 2 BalletGrade 3 BalletGrade 1 TapGrade 3 TapSenior BalletContemporaryMini's Acrobatic Dance (Tuesdays)Mini's Acrobatic Dance (Saturdays)Junior Acrobatic Dance (Tuesdays)Junior Acrobatic Dance (Fridays)Intermediate Acrobatic Dance (Wednesdays)Intermediate Acrobatic Dance (Fridays)Advanced Acrobatic DanceTiny DiscoTiny Ballet & TapPrivate LessonWorkshop Emergency Contacts Name of Parent or Guardian* First NameLast Name First Emergency Contact* First NameLast Name Phone Number* -Area CodePhone Number Second Emergency Contact* First NameLast Name Phone Number* -Area CodePhone Number Does your child have any medical conditions we should be made aware of? NoYes Do you have any medical conditions we should be made aware of? NoYes If yes please list them Parent / Guardian Release Form* I the undersigned GIVE PERMISSION for LB Dance to use any still or moving images or audio recordings of my child (named above) for any of the following uses:I the undersigned DO NOT GIVE PERMISSION for LB Dance to use any still or moving images or audio recordings of my child (named above) for any of the following uses: Adult Release Form* I the undersigned GIVE PERMISSION for LB Dance to use any still or moving images or audio recordings of myself for any of the following uses:I the undersigned DO NOT GIVE PERMISSION for LB Dance to use any still or moving images or audio recordings of myself for any of the following uses: Advertising Marketing Education Publicity Signature* Clear Name* First NameLast Name E-mail* example@example.com Would you like to be added to the LB Dance Mailing list to receive updates and information about classes? YesNo Where did you hear about us? Facebook Google search Other search engine Flyer Recommended by someone you know Let us know who recommended us so we can thank them. Submit Should be Empty:
