Registration Form

Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Medical conditions/Allergies
Parent/Guardian name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
Emergency contact

First Name Last Name
Emergency phone number

Area Code Phone Number
E-mail
Work Number

Area Code Phone Number
Class Enrolment

please complete by ticking applicable boxes.
RAD Ballet

Pre-Primary Primary Ballet exams Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Intermediate Foundation Intermediate Advanced Foundation/1 Progressing Ballet Technique Pointe & Preparation
Acrobatic Arts

Junior Intermediate Senior Tumbling
Hip Hop

Junior Intermediate Senior Boys
Jazz

Transition Junior Intermediate Senior
Irish

Combined Irish
Musical Theatre

Musical Theatre
Modern/Contemporary

Intermediate Senior
Miscellaneous

Stretch Private lesson Troupe Member (Audition required) Adults Zumba (Tuesday/Thursday) Dance Ability
Tap

Junior/ Intermediate Tap
Tots Classes

Ballet (Monday) Ballet (Tuesday) Jazz Tap Acro Creative Dance (Thursday) Creative Dance (Friday) creative Dance (Saturday) Irish
Fees

Please Note:
- All classes within the term must be paid for whether attended or not. Refunds will not be issued.
- If no payment has been received by WEEK 4 of term, you will receive a notification advising you that your child will have to cease their lessons until payments are up to date and a $10.00 late fee will be charge per week, as from week 4 of the term.
I agree to the payment terms set out above by Bathurst Academy of Dance.
Yes No
Signature

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Photography Permisson

I give permission for my son/daughter to be videoed or photographed whilst dancing with/for Bathurst Academy of Dance.

I also understand that at times teachers may use physical contact when helping improve my child's posture or to assist in learning a movement. Your signature below confirms your consent of this method of teaching.
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Signature

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Date

Month Day Year
Date
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Class Enrolment