Student information First Name* Last Name* Date of Birth* New or returning student* New student Returning student Contact details Parent/Guardian 1 - name* Parent/Guardian 1 - telephone* Parent/Guardian 2 - name Parent/Guardian 2 - telephone E-mail* Street Address* Suburb* Postcode* Medical conditions Does the student have any medical conditions we should be aware of?* Yes No If yes, please provide details Enrolment details Ready Set Dance Level 1 (2-3yrs) - Tuesday 9.30-10.30am Level 1 (2-3yrs) - Thursday 9.30-10.30am Level 1 (2-3yrs) - Saturday 9.30-10.30am Level 2 (4-5yrs) - Tuesday 11am-12pm Level 2 (4-5yrs) - Thursday 11am-12pm Level 2 (4-5yrs) - Saturday 11am-12pm Ready Set Ballet Tuesday - 10.30-11am Thursday - 10.30-11am Saturday - 10.30-11am Ready Set Dance Uniform Tutu Leotard T-shirt Ready Set Ballet tutu Release and Waiver The above information is true to the best of my knowledge. I understand that dance instruction requires physical exertion. I also acknowledge that injury may result during instruction, including but not limited to, as a result of physical contact with other students, instructors, fixed or movable objects, or the condition of the floor. I represent that I am medically and physically able to safely participate in dance classes, workshops, rehearsals and performances, and to meet the physical demands thereof. If at any time I have any medical or physical limitations, or a condition that may affect my ability to safely participate in dance classes, workshops, rehearsals, photo shoots or performances, I will make such limitations and conditions immediately know to Vanesa Lee Dance Academy. In view of the foregoing, and as a term and condition of receiving dance instruction from Vanessa Lee Dance Academy, I expressly release, waive and discharge Vanessa Lee Dance Academy, its officers, directors and employees from all present and future claims, demands, actions, judgments, executions, and liabilities of any kind. I understand that no staff supervision will be provided in waiting rooms, bathrooms, empty studios and the carpark, and that if I choose to leave my child unsupervised at the studio, I do so at my own risk. I give permission to receive medical assistance if required, and agree that I am liable for any costs associated with medical assistance, including but not limited to, transport by ambulance. I give permission to be photographed and/or filmed during Ready Set Dance classes, workshops, rehearsals and performances, and for said images and video footage to e used by Vanessa Lee Dance Academy for marketing purposes, both online and in print. I hereby represent that I am the guardian of the participating student and that I will abide by all terms and conditions as set out by Vanessa Lee Dance Academy, including the above release and waiver.* Yes How did you hear about the Vanessa Lee Dance Academy? Returning student Word of mouth Internet search Dapto Flyer Facebook Instagram Other Submit enrolment off
