JUMP Dance Academy Registration Form
Please fill out one form per child, prior to your child’s first class.

The information you provide in this form will be treated as confidential and may be accessed by JUMP Dance Academy staff only if and when necessary for the health and safety of your child.
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Data Protection: We require your contact details so that we can reach you in case of emergency. We will also use your contact details to send you information about relevant news, classes, exams, fees and performances. Your details will be kept on file by JUMP Dance Academy for these purposes only and will not be passed on to any third parties. *
Required
Which class/es is your child enrolling for (please include style, age and location)? *
Child's first name(s) *
Child's surname *
Child's date of birth *
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Does your child have any medical conditions that may affect his or her participation in class? Please list.
Is your child taking any medications we should be aware of, such as an inhaler? Please list.
Does your child have any allergies? Please list.
Any other relevant information.
Parent/guardian name *
Relationship to child *
Address (for contact and invoicing purposes) *
Telephone number *
Additional telephone number
Email address *
In case of emergency, in the first instance we will always endeavour to contact the parent/guardian named above. However, if we are unable to reach them, please tell us who we should contact instead:
Relationship to child
Telephone number
How did you hear about us?
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May we use photos/video of your child for publicity (website, social media, flyers etc)? *
Declaration: The information I have provided is correct at the time of signing. I understand that I must contact JUMP Dance Academy as soon as possible if any of this information changes. By completing this form I confirm that I have read and agree to the terms of enrolment which can be downloaded here: https://drive.google.com/file/d/1rwn6BH7S6q6EfEfFQjhkXljPPCUc0uEx/view *
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