Students Name:

Students Address:

Students D.O.B:

Students Contact Number: (Wk)                                 (Hm)                                           (Mb)

Students Main E-mail Address (for newsletters & important information):

Classes Attending:

Has the student had any related experience in dance in the past? Y[  ] N[  ]

Details:

Mothers Name:

Mothers Home Address:

E-mail Address:

Mothers Contact Number: (Wk)                                 (Hm)                                           (Mb)

Fathers Name:

Fathers Home Address:

E-mail Address:

Fathers Contact Number:  (Wk)                                  (Hm)                                           (Mb)

Two Emergency Contacts:

(1) Name                                                             Relation                                            (Ph)

(2) Name                                                             Relation                                            (Ph)

Has the student any medical history or allergies that Dance Junction should be aware of? (such as asthma, bees or bad back)
Y[  ] N[  ] please specify

Does the student need to take medication? Y[  ] N[  ] please specify

Would you consider helping Dance Junction?  Y[  ] N[  ] (for example with making props, sewing, advertising, sponsorship, materials, volunteering at concerts etc)

Details:

Please tick to indicate how you found out about Dance Junction?
Radio [  ] T.V [  ] Newspaper [  ] Pamphlet [  ] Friend [  ] Sign [  ] Other [  ]

All products of Dance Junction including, music, routines, and costumes remains the property of Dance Junction and can not be replicated.  Sales of costumes need to be discussed before hand with principle of Dance Junction.  Dance Junction will not be held responsible for any injuries which may occur whilst in class or on the premises, but will seek medical attention for your child immediately if needed.  I understand to provide adequate dance tuition it is necessary for dance teachers to guide student movement, which may require physical contact.  I agree with these terms and conditions and will also agree to pay an annual enrolment fee of $30.00 for each child enrolled on or by the first day of class.  I agree term fees will be paid prior to commencement of each term and that there are NO REFUNDS on any payment of term fees or costume hire.  If term fees are not paid prior to each term the child will be unable to attend class unless the parent has made suitable arrangements with the teacher to organise payment.  The guardian has received an Information booklet.  By signing this form you are giving consent for Dance Junction to use photographs and/or video footage of the dance student for promotional purposes e.g. website, newspapers, events, or shopping centres (please note, individuals will not be named unless permission has been granted from parent/guardian).  Please be aware that Dance Junction has the right to sell videos of students who participate in the end of year concert and group photos.  Original photographs/videos taken by staff are held securely at the postal premises of Dance Junction.  During the period of participation within Dance Junction it is the responsibility of the guardian or student to advise Dance Junction if personal circumstances / information change.

Name:                                                                            Signature                                                          Date           

Witness Name:                                                              Signature                                                          Date