Miss Jolene's School of Dance

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
- Yes Please
- No
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07528014855