Registration / Enrolment Form


Welcome!

For the safety and protection of all dancers in our care, a completed enrolment form must be submitted before attending any class or private lesson at Red Shoes Dance.
 
Fields marked * are required
Student's Full Name: *
Date of Birth: 
Parent/Guardian/Carer's full name: *
(for child enrolments)
Address: *
Email: *
Best contact telephone number: *
Does the student have any medical
conditions we should know about? *		 No
Yes
If Yes, please provide details:
Adult Class or Private Lesson? *
How did you hear about us?  Internet Search
Red Shoes Website
Facebook
Google Places/Google+
Online Directories (Kidspot etc)
Referral (friends/family)
Print media
Existing Student
Other:
Please acknowledge by ticking the box below...
* I hereby indemnify Red Shoes Dance and its staff against responsibility for any accident loss or injury suffered by the student during the course of a dance class
Please acknowledge by ticking the box below...
* Should at any time staff consider that the student requires medical treatment, I consent to your obtaining some at my expense
For Child enrolments please acknowledge by ticking the box below...
* I understand that Red Shoes Dance and its staff are only responsible for my child during set class time
 
NAME OF PERSON completing this online form: *