Name of Student (required)

Class Attending (required)

Name of Parent/Guardian

Email Address

Students Date of Birth

Contact Number (Mobile)

Emergency Contact Number

Any relevant medical conditions

I am happyI am not happy

For my child to participate in dance Performances and to be
included in any pictures taken during any dance shows that my child
may be dancing in.

I hereby agree to pay after initial first week trial, fees in advance
of half term block payments.

I hereby agree to give a half term paid notice if I choose for my child to
leave Contrast Dance Classes.

Print Name

Date of Digital Signature