Registration Student Information Student 1 Name (required) Student 1 DOB (required) Student 2 Name Student 2 DOB Parent Information Parents' Names (required) Your Email (required) Your Address Mum's Phone Dad's Phone Medical Information Emergency Contact (if different from above) Notes (Asthma, Injuries, Allergies, etc...) Select Your Class (required) Monday 3yr Ballet Monday 4yr Ballet Monday 2yr Ballet Monday Boys Dance Tuesday 3yr Ballet Tuesday 4yr Ballet Tuesday 4yr Acro Tuesday 4yr Jazz Wednesday 3yr Ballet Wednesday 4yr Ballet Thursday 3yr Ballet Thursday 4yr Ballet Thursday 4yr Jazz Thursday 4yr Acro Saturday 3yr Ballet Saturday 4yr Ballet Acceptance By selecting this checkbox, I, whose name appears above in consideration of and as a condition of acceptance of my entry in this event, for myself, my heirs, executors and administrators, hereby waive all and any claim, right or cause of action which I or they might otherwise have for or arising out of loss of my life or injury, damage or loss of any description whatsoever which I may suffer or sustain in the course of or consequent upon my entry or participation in the said event. I will abide by the studio rules. Please note: By submitting this enrolment form, you give full rights to Bellarine Academy of Dance and it's staff, to use photo or video images of you and your child for promotional purposes of the studio only. Photo and video images will not be used for any other purpose. Should this create any concerns please feel free to contact the school.