Welcome to Showtime Circus - Bernadine Soul School of Dance

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Registration Form

Child's First Name: *

Child's Last Name: *

Child's Birthday *

YYYY

Parent/Guardians Name: *

Relationship to child: *

Emergency Phone Number: *

Address including Post Code: *

Email: *

Which class are you signing up for: *

Popcorns (Age 3-5)

Big Tops (Age 6-10)

Required

Have you secured your trial(s) with us by paying your fee(s)? *

Yes

If no, please COMPLETE YOUR PAYMENT now using the relevant link(s) below:

PLEASE ENSURE YOU RETURN TO THIS FORM, ON COMPLETION OF PAYMENT, TO CONTINUE FILLING OUT YOUR DETAILS.

Big Tops Trial Class

Popcorns Trial Class

We require your child to attend Trial Classes before enrolling to regular class. Thank you!

Does your child suffer from any allergies?
*

Does your child have any medical or learning conditions?
*

If Yes, please comment below telling us more about how we can support your child's needs?

Terms, Conditions and Policies

Please read our Terms and Conditions before continuing with this form. By signing this form you are stating that you are in agreement with all of the terms and conditions set out. 

Please indicate you agree to the below by checking each box
*

The information I have provided is true and current

I have read the terms and conditions and agree to these

I agree to photos/videos being taken of my child and used for marketing or promotional purposes

Required

Signature (PLEASE TYPE FULL NAME. This will be accepted as the equivalent of a written signature)
*

Date signed
*

YYYY

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