Student Name__________________________________________________

Address________________________________________________________

Phone_______________________ Mob:______________________________

Fax________________________ Email_______________________________

Date of Birth_______________________ Age on 1st January_________

Childs clothing size: Top............. Bottom...................

CLASS (Please Circle)

R.A.D. Ballet

Tap

Jazz

Tap/Jazz Combo (Must be 12yrs or Under on 1st Jan 2010)

Hip-Hop

Pointe

Limbering

Rep (Conditions Apply)

Tot-Time

Overseas Dance Experience (Conditions Apply)

PLEASE CIRCLE BELOW ANY THAT ARE APPLICABLE:

RAD Classical Exams ~ Yes/No

RAD Classical Presentation ~ Yes/No

In class progress report ~ Yes/No

Eisteddfod ~ Yes/No

Concert ~ Yes/No

Professional Photo's ~ Yes/No

I AM WILLING TO HELP WITH: (PLEASE CIRCLE)

Props

Hair

Make-Up

Sewing

Hair-Piece making

Concert Night (Selling Tickets, ushering, etc.)

I agree to my child/ward to have any photo's taken used for publicity purposes........... Yes/No

Signature................................