Dancers Details *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Phone *

(###)

###

####

Additional Emergency Contact Name *

First Name

Last Name

Phone *

(###)

###

####

What classes would you like to enrol in? *

Age at 1st of January for year wishing to enrol in

Koalas - Ballet 3 & 4 year olds

Echidnas - Ballet 5 & 6 year olds

Grade 2 Ballet - 7 & 8 year olds

Junior Hip Hop - 6 - 11 year olds

Adult Dance Class

Private Lessons

Photography & Videography Consent *

I consent to Encore Studios taking and posting photos and videos of myself/child for educational and marketing purposes.

Yes

No