Anita's Dance Academy - School holiday dance explosion workshop registration form 11th July 2019

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Please fill in all the details below to secure your spot in the workshop - we are running only 1 full day this holidays. Numbers are limited due to studio size.
In order to confirm your booking payment will be required either online (bank account below) or in a named envelope in cash to Anita at the studio. This form must be filled in by the parent, caregiver or guardian for the children you are registering for this workshop, you will be the emergency contact for the following children on the days they are at the workshop.

Parent or guardian name *

Email address *

Mobile phone number *

Childs name *

Age group *

5 - 8 yrs

9- 14 yrs

Second child if applicable

Age group

5 - 8 yrs

9- 14 yrs

Clear selection

Third child if applicable

Age group

5 - 8 yrs

9- 14 yrs

Clear selection

My child or children have danced before *

Yes

Some have

Required

I have paid to secure the space for my child/children. First and last name as the reference and holiday as the particulars (bank details are 06 - 0773- 0241834- 00) *

Paid online (please use your name as a reference)

Paying in cash at the studio (please put in an envelope named and give to Anita)

My child has a medical condition or disability *

Yes

If you answered yes please specify the details

Submit

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