Lynden Enrolment Form

Co4IT Limited

“Lynden for a lifetime...”

Dance Class Requested

- please ensure a class is selected

Preferred location

I do NOT want my child to be included in any publicity

This Enrolment Form will be submitted to the Lynden School of Dance.

Parent/Guardian first name

Parent/Guardian Surname

Address

Town/City

County

Postcode

E-mail Address

Home Telephone

Mobile

Work Telephone

Alternative Emergency Phone Number

Student first name

Student Surname

Date of Birth

Important Medical Information

Other Relevant Information

I have read and agree to the Terms and Conditions

I have read the legal disclaimer opposite

To prevent spamming from applications, please type the characters shown into the box below:

Legal disclaimer:

I give permission for the aforementioned student to participate in classes run by The Lynden School of Dance. Lynden School of Dance classes in Basingstoke are run in conjunction with Basingstoke Sports Centre.

I confirm that I have read and accept the 'Terms & Conditions' as laid out by The Lynden School of Dance.

I understand that whilst every effort is made to ensure the safety of all participants, all physical activity carries a certain amount of risk.

I understand that the students(s) participate at his or her own risk. I accept that all belongings brought in by students are done so at their own risk.

I understand that from time to time photographs and video footage may be taken for publicity purposes and unless stated otherwise as per attached, I am happy for my child to be included in this publicity.

Payment for Courses:

Payment for dance courses with the Lynden School of Dance should be made in advance by PayPal using “lyndendance@aol.com”, by cheque or, at the latest, on attendance at the first class of the course. Cheques to be made payable to “The Lynden School of Dance”.

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