Online Enrolment Form

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Please fill out the form below for Online Enrolment at JG Dance.

Parent/Guardian Name*

Student Forename*

Student Surname*

Student Date of Birth*

Student Age*

Address Line 1*

Address Line 2

Town*

Postcode*

Home phone number*

Work phone number*

Mobile phone number*

Parent Email Address*

Emergency contact name*

Emergency contact number*

Branch Location*

Date of Trial*

Medical history (Please state N/A if this does not apply)*

Previous experience or examinations

How did you hear about us?

Notes

By clicking the box above you are agreeing to the full terms and conditions.

I understand that my child may be photographed or filmed for promotional use.

I agree to administration of medical help should the need arise and that the signing of this form is consent.

I agree to give a full 8 week terms notice in writing in the event of withdrawing my child from classes or fees in lieu for the full 8 week term.*

Please leave this field empty.