Enrolment Form

abilities, not disabilities.

Please fill out the registration form below if you wish to enrol into a Dance 4 All class. Understand that spots are limited and are subject to availability. We are looking forward to hearing from you!

Student's Name *

First

Last

Birthdate *

Class enrolling in (eg: Kinder-Ballet, All-Abilities etc) *

Current Diagnosis (if any)

Medical Conditions (eg: Asthma, Anaphylaxis, Epilepsy)

Parent/Guardian Name #1 *

First

Last

Relationship to student *

Mailing Address *

Suburb *

State *

Postcode *

Phone Number *

Email *

Parent/Guardian Name #2

First

Last

Relationship to student

Mailing Address

Suburb

State

Postcode

Phone Number

Email *

How did you find us?

Please let us know anything that will help our staff provide the best possible learning experience for your child (sensitivities, developmental goals, behaviors, what helps self-regulation…) *

We take the privacy of you and your family seriously. Your agreement to allow us to share information, testimonials, videos, images, etc. will help us to reach other students who can benefit from the Dance 4 All Program. It will also help us in data collection to refine the program to be more effective and beneficial for all students. Please know that we will never use your child’s name in conjunction with any of the following scenarios that you do approve.

Yes, I understand

Permission to provide first aid and seek medical attention should the need arise. *

Agree
Disagree

Share verbal (written or recorded) testimonials of my or my child’s experience with Dance 4 All. *

Agree
Disagree

Use video of my child in advertisements to promote classes for Dance 4 All. *

Agree
Disagree

Use imagery of my child in advertisements to promote classes for Dance 4 All. *

Agree
Disagree

Please list any other specific scenarios that you wish to allow or disallow that are not listed above: