Student Name *

First Name

Last Name

Student Date of Birth *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Secondary Contact Name *

First Name

Last Name

Secondary Contact Phone *

(###)

###

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Disclaimer *

In the event of a medical emergency and where a parent or guardian cannot be contacted, I authorise the Studio Dance Collective personnel to seek medical advice and treatment for my child/student.

All information completed on this form is true and accurate.

I understand that students attend Studio Dance Collective classes and activities at their own risk.

I confirm I have read and understood the Terms & Conditions, Child Protection Practices and Code of Conduct. (found in Quick Downloads)

Studio Dance Collective takes Child Protection Laws seriously. By ticking this box, you give Studio Dance Collective permission to publish any photos taken. If you do not wish for photos of your child/children to be taken, please email StudioDanceCollective@outlook.com