Class Enrolment

Child's Name*
Last Name:
Nickname:
Email address:
Phone number:
Nights available:
Age  21+ Under 21
Do you have a digital camera?  Yes No
Do you have high-speed Internet?  Yes No
How did you hear about us?
Please list two employment references (name, contact info, what you did for them):
Tell us about the funniest thing you've seen or heard this week:
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Enter Random Code:

Child's Name*

Child's Age*

Child's Date of Birth*

Email Address*

Address*

Suburb*

Post Code*

Parent(s) Name*

Phone Number(s)

Academy

Studio

Class

Photographs
We occasionally take pictures of children in class to use in publicity material, such as our newsletter or our websites.
Please indicate your consent or otherwise by selecting below.

 I am Happy for my child to appear in photographs and on the website. I would rather not have my child appear in photos

Please list any physical or learning difficulties experienced by your child:

Where did you hear about the academy?

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