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……………………………………………………… |
Andrea Rowsell Academy of Dance 