Registration form for dance classes- Leap Dance Midlands

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Registration form for Leap Dance Midlands

Name of Parent/ Guardian *

Name of child/ children *

Age and Date of Birth of child/ren *

Mobile Number

Email address *

Class interested in registering in

Toddler and Grown Up class

Primary Class (aged 3 and up)

Junior Class (aged 6 and up)

Senior Class (10 and up)

Adult Ballet Be Fit/ Adult Ballet

Clear selection

Village location for classes- Repton or Tutbury

Preferred day and time of class- Please note not all these times and days will be on offer, I am trying to find a day and time that is most convenient for you all. So please let me know all the ones that you can do. Thanks for your help. Mondays after school (and preferred time) Tuesday after school (and preferred time) Wednesday after school (and preferred time) Thursday after school (and preferred time) Friday after school (and preferred time) Saturday morning Saturday midday *

Please outline any health and medical needs. Please include any allergies. Please outline any medication needed. *

I consent to Leap Dance Midlands sending me emails about their classes and other information. No information will be shared with any other parties. *

I agree

Required

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