Enrolment Form

Surname*
Given Name*
Date Of Birth*
Age As Of 01/01/2020:
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Home Phone
Work Phone
Mobile Phone*
Parent/s Names*
Email Address*
In Case Of Emergency Contact*
Emergency Phone*
Relationship
Class Choice/s*
- Tuesday Sub-Juniors 4.00pm
- Tuesday Inters 4.30pm
- Tuesday Young Seniors Hip Hop 5.30pm
- Tuesday Young Seniors 6.30pm
- Tuesday Seniors 8.00pm
- Wednesday Inter Hip Hop 5.15pm
- Wednesday Senior Hip Hop 6.00pm
- Wednesday Advanced Seniors 6.00pm
- Wednesday Advanced Senior Hip Hop 8.30pm
Medical Conditions/Allergies
Terms & Conditions*
- I Agree
- I Don't Agree
I, (as parent/guardian of the student) hereby agree to all the terms & conditions as set by DANCE FACTOR and understand that no liability will be taken for loss or damage of property or any physical injury caused whilst at DANCE FACTOR premises.
Advertising*
- I Agree
I, (as parent/guardian of the student) hereby give DANCE FACTOR permission to use images of my child for advertising on promotional materials or social media.
Name
This field is for validation purposes and should be left unchanged.

2020 CLASSES COMMENCE TUESDAY FEBRUARY 4th!!!