Dance Academy Enrolment Form

Co4IT Limited

Dance Class Requested

Parent or Guardian Information

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 Information

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

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

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

Legal disclaimer:

I give permission for the aforementioned student to participate in classes run by the Dance Academy in association with The Lynden School of Dance and 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 all dance courses with the Dance Academy should be made to The Basingstoke Sports Centre.

All Dance Academy courses are offered in conjunction with the Basingstoke Sports Centre.