ENROLMENT

Strong. Active. Graceful.

Loyalty dance co 2019

ENROLMENT FORM


Student name ____________________________________________


DOB___________________________


Email____________________________________


Mobile___________________________________


Emergency Contact


Name _____________________________________


Phone_____________________________________


Illness/injuries that may need to be notified for your child’s safety, 

________________________________


Please circle:


WOODHILL                 NERANG




Media release


Please Sign below if you give permission for your child’s photos to be used for social media and advertising purposes.


YES


NO



Guardian’s name ________________________________________



Guardian’s signature_____________________________________


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To complete enrolment, please tick the box confirming you have read and agree to Loyalty dance co’s Terms and conditions.


I Agree to the Terms and Conditions*

__________________________________


Please Email to loyaltydanceco@outlook.com

Or hand to miss Jane

 

©2016 by loyalty dance co.

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