The Edge Ballet Academy Enrolment Form 2012

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* Required fields
Name *
E-mail Address *
Title (Parent/Caregiver 1): *	Mr Mrs Dr Ms Miss Other
If other please specify
Name (Parent/Caregiver 1): *
Title (Parent/Caregiver 2):	Mr Mrs Dr Ms Miss Other
If other please specify
Name (Parent/Caregiver 2):
Address *
Home Phone
Mobile Phone *
Student's First Name *
Student's Last Name *
Student's D.O.B *
Student's Age (as at 1st January 2012) *
Student's Gender *	Male Female
Student RAD id examination number (only if thay have one)
Student Mobile (only if they have one)
Student Email (only if they have one)
Previous dance experience
Are you a current Edge student? *	Yes No
Medical Information
Does your son or daughter suffer from any allergies? *	Yes No
If yes, what is the treatment?
In case of an Emergency and a parent/caregiver cannot be contacted please notify:
Please list the classes you wish to enrol in *
Would you like to request a Private Lesson?	Yes No
If so, please specify which teacher you would like
How did you hear about us? *
If other, please list
I agree to allow myself or my child to be photographed/filmed *	Yes No
Have you read and do you agree to the terms and conditions? *	Yes, I agree No, I disagree

I have read and agree to the Privacy Policy *

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"To Dance is to Live, To Live is to Dance."