ENROLMENT FORM 2020

STUDENT DETAILS   Given Name………………………………………………………. Surname………………………………………………………. Date of Birth…………………………                                    Male/Female (circle) Postal Address…………………………………………………………………………………………………………………………… Postcode………………………..                                           Phone…………………………………………………………..        
PARENT/GUARDIAN INFORMATION   Mother……………………………………………………….         Father…………………………………………………………… Mobile…………………………………………… …………         Mobile…………………………………………………………… Email…………………………………………………………         Email……………………………………………………………..  
STUDENTS ACCOUNTS   Name of person responsible for paying accounts:……………………………………………………………………………. Address of person responsible for paying accounts:………………………………………………………………………… …………………………………………………………………………………………………………………………………………………  
PERSON OTHER THAN PARENT TO CONTACT IN AN EMERGENCY   NAME.…………………………………………………………………………………………… RELATIONSHIP TO STUDENT……………………………………………………… PHONE…………………………………………………………………………………………..  
MEDICAL DETAILS   MEDICAL CONDITIONS(e.g. .Allergies, Asthma, Epilepsy)……………………………………………….. DO WE HAVE PERMISSION TO TAKE YOUR CHILD TO THE NEAREST HOSPITAL OR DOCTOR FOR MEDICAL ATTENTION IF THE NEED ARISES? YES/NO(circle)SIGNED…………………………………………………………………………………………………..
ACCETANCE OF TERMS AND CONDITIONS I have read and agree to the terms and conditions overleaf for my child and agree to all the conditions listed by Andrea Rowsell Academy of Dance.   SIGNED………………………………………………………....DATE………………………………………………………