REGISTRATION FORM

Name

Email

Address

Date Of Birth

Telephone No.

Parent/Legal guardian name

Parent/Legal guardian name

Telephone No.

Telephone No.

Dance Class Attending Dance Class AttendingDancerellasDance Stars JuniorsDolly RockersYouth Dance Stars

Any medical history/allergies or special needs? * If yes please provide details below Any medical history/allergies or special needs? * If yes please provide details below Yes No

Additional Info

I give permission for emergency first aid to be given if deemed necessary by a qualified first aider I give permission for emergency first aid to be given if deemed necessary by a qualified first aider Yes No

Please indicate below if you are happy for us to use your child's photograph for use on our website, social media platforms and newspapers etc. Please indicate below if you are happy for us to use your child's photograph for use on our website, social media platforms and newspapers etc. Yes No

Dance Stars Academy is not Liable for personal injury or loss/damage to personal property.

Signature

Date