2016 student enrolment form

Studio: Cnr Atticus St & Salter Cl, WOREE
Web: www.dance2xs.net.au
Email: [email protected]
Phone: (07) 4033 5315
2016 STUDENT ENROLMENT FORM
Please complete and return this form with your enrolment fee of $30.00 to secure your childs place with
Dance 2XS. This non-refundable enrolment fee is payable per student each year and includes insurance
cover for each student, as well as covering PPCA & APRA AMCOS music license fees, administration fees,
and also a very special trophy for every Dance 2XS student which is presented at the end of the year.
Students Name: ________________________________________________________________________
Date of Birth: _______ / _______ / _______
Start Date: ______________________________
How did you hear about us? ______________________________________________________________
PARENT / GUARDIAN DETAILS
Parents Name: _________________________________________________________________________
Home address: ________________________________________________________________________
Billing Address: as above  YES or ________________________________________________________
Home Ph: ______________________________
Mobile Ph: ______________________________
Email: ________________________________________________________________________________
MEDICAL DETAILS
Does your child have any medical conditions or learning difficulties?
 YES
 NO
_____________________________________________________________________________________
_____________________________________________________________________________________
(If you answered yes to the above question please consult with your doctor or therapist for advise before
your child commences dance classes and inform us of any relevant information we should know)
CLASSES ENROLLED IN (tick)
Mummy & Me Dance
Junior Cheerleading 1
Tiny Tots Gym
Junior Cheerleading 2
Tiny Tots Tap
Junior Cheerleading 3
Kindy Dance
Intermediate Cheerleading 1
Rising Starz
Intermediate Cheerleading 2
Junior Funky Jazz
Intermediate Cheerleading 3
Intermediate Funky Jazz
Senior Cheerleading 1
Senior Jazz & Contemporary
Senior Cheerleading 2
Beginners Ballet
Advanced Cheerleading
Senior Ballet
Tumbling & Acrobatics 1
Beginners Tap
Tumbling & Acrobatics 2
Senior Tap
Tumbling & Acrobatics 3
Junior Hip Hop
Tumbling & Acrobatics 4
Senior Hip Hop
Tumbling & Acrobatics 5
Pre Junior Cheerleading1
Tumbling & Acrobatics 6
Pre Junior Cheerleading 2
PHOTO/VIDEO RELEASE & INDEMNITY
I am the parent/guardian for the student and I have the authority to sign and give this release and indemnity
for or on behalf of them.
I agree to give Dance 2XS consent to allow photographs and/or video footage to be taken of my child
during class, performances and events for the purpose of Dance 2XS promotion. I give permission for the
images and footage to be included in but not limited to media such as printed and online material.
I give permission for my child to attend and partake in all activities of the Dance 2XS classes. I understand
my child will be participating in dancing, cheerleading and acrobatics which despite all safety precautions can
result in accidental injury. I release discharge and indemnify Dance 2XS and it’s employees now and forever
from and against all claims, actions or demands arising in any way from the student’s involvement in classes
and any injuries suffered by the student before, at or after the classes.
I agree to the Dance 2XS terms of enrolment and I give permission for Dance 2XS staff to act on my child’s
behalf in an emergency should medical treatment be required and I am uncontactable.
Signed: ________________________________________
Date: ____________________________