REGISTRATION FORM

Registration form for Miss Jolene's School of Dance 2020/2021

Parent Name*

Student Name*

Student DOB*

Address*

Address 2 (optional)

Contact Number 1*

Contact Number 2*

Contact Number 3 (optional)

Primary Email Address*

Email 2 (optional)

Name of person/s responsible for dance fee payments*

Medical Information to be recorded*

Allergies to be recorded*

Anything else

Class/es I am enrolling for*

We require your consent before photographing/recording your child during a Miss Jolene's School of Dance Class or Event. Please read through the following statements carefully and acknowledge your decision. Your child will NOT be photographed/videoed during the trial period. You can change you decisions at any time by emailing us at [email protected]

I give consent for my child to be photographed/videoed at Miss Jolene's School of Dance Class or Event*

I give consent for my childs image to be used in printed publications, such as posters, leaflets, newspapers*

I give consent for my childs image/video to appear on Miss Jolene's School of Dance Website*

I give consent for my childs image/video to appear on Miss Jolene's School of Dance Social Media Platforms*

Please send me a uniform order form

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