Family Name (required)
First Name (required)
Street No. (required)
Street Name (required)
Date of Birth (required)
Please tick if you are the Emergency Contact
(If you are the Emergency Contact, all boxes are required to be completed)
I acknowledge that I am aware there is an inherent risk of injury or ill health resulting from the facilities and services from the participation in dance programs generally.
I therefore undertake to utilise these services only at my own risk and I hereby waive on behalf of myself, my heirs and executors hereafter liability against In Rhythm Dance Company for any injury, illness or adverse changes in my medical condition or state of health (whether permanent or temporary), arising directly or indirectly from my use of the services provided, whether supervised or not by the In Rhythm Dance Company staff.
I acknowledge that I am aware that I may be photographed or videoed during a performance and this may be used as promotional material or on In Rhythm Dance Company’s website or Social Media.
I acknowledge that non payment of fees will result in a "no entry policy" and if I am unable to attend a class fees are still payable. Exceptions may apply where prior arrangements have been made or a student has an injury, e.g. a broken bone or a contagious disease. Fees are non refundable.
If the participant is under 18, this form must be signed by the child's Parent or Legally Appointed Guardian, NOT an older sibling or grandparent.
Please list any known allergies or medical conditions:
If you are a new student or existing student and would like to enrol in different classes in 2016 please select below classes you are interested in:
Ballet -- Preferred Day --MondayTuesdayWednesdayThursdaySaturday -- Second Preference --MondayTuesdayWednesdayThursdaySaturday
Tap -- Preferred Day --MondayTuesdayWednesdayThursdaySaturday -- Second Preference --MondayTuesdayWednesdayThursdaySaturday
Jazz -- Preferred Day --MondayTuesdayWednesdaySaturday -- Second Preference --MondayTuesdayWednesdaySaturday
Tiny Tots -- Preferred Day --MondayTuesdaySaturday -- Second Preference --MondayTuesdaySaturday
Hip Hop -- Preferred Day --Wednesday -- Second Preference --Wednesday
INTERESTED IN PERFORMANCE