2022 Enrolment Form

Dancer One

Dancer Details

Dancer One Name

First Last

Dancer One Date Of Birth

Dancer Level

Class Selection

Please provide class name, day and time

Class One

Class Two

Class Three

Class Four

Class Five

Class Six

Class Seven

Class Eight

Class Nine

Class Ten

Medical History

Please provide dances medical details below

Do you have any allergies?*

Do you have any allergies?

Yes
No

Do you have a current Medical Condition?*

Do you have a current Medical Condition?

Yes
No

Do you have any current or previous injuries?*

Do you have any current or previous injuries?

Yes
No

Have you ever experienced a Fracture/Dislocation?*

Have you ever experienced a Fracture/Dislocation?

Yes
No

Have you ever experienced a Head/Neck/Spinal injury?*

Have you ever experienced a Head/Neck/Spinal injury?

Yes
No

Do you experience recurring Joint Pain with movement?*

Do you experience recurring Joint Pain with movement?

Yes
No

Do you wear Glasses/Contact Lenses?*

Do you wear Glasses/Contact Lenses?

Yes
No

Do you, or have you ever had, any of the following conditions?

Epilepsy
Diabetes
Asthma
Other Breathing Difficulties
Health Difficulties
Concussion
Hernia
Hepatitis A or B
Cancer

Additional Details

If you selected yes for any of the above please provide any necessary details below

Additional Medical Details

Dancer Two

Dancer Details

Dancer Two Name

First Last

Dancer Two Date Of Birth

Dancer Level

Class Selection

Please provide class name, day and time

Class One

Class Two

Class Three

Class Four

Class Five

Class Six

Class Seven

Class Eight

Class Nine

Class Ten

Medical History

Please provide dances medical details below

Do you have any allergies?*

Do you have any allergies?

Yes
No

Do you have a current Medical Condition?*

Do you have a current Medical Condition?

Yes
No

Do you have any current or previous injuries?*

Do you have any current or previous injuries?

Yes
No

Have you ever experienced a Fracture/Dislocation?*

Have you ever experienced a Fracture/Dislocation?

Yes
No

Have you ever experienced a Head/Neck/Spinal injury?*

Have you ever experienced a Head/Neck/Spinal injury?

Yes
No

Do you experience recurring Joint Pain with movement?*

Do you experience recurring Joint Pain with movement?

Yes
No

Do you wear Glasses/Contact Lenses?*

Do you wear Glasses/Contact Lenses?

Yes
No

Do you, or have you ever had, any of the following conditions?

Epilepsy
Diabetes
Asthma
Other Breathing Difficulties
Health Difficulties
Concussion
Hernia
Hepatitis A or B
Cancer

Additional Details

If you selected yes for any of the above please provide any necessary details below

Additional Medical Details

Dancer Three

Dancer Details

Dancer Three Name

First Last

Dancer Three Date Of Birth

Dancer Level

Class Selection

Please provide class name, day and time

Class One

Class Two

Class Three

Class Four

Class Five

Class Six

Class Seven

Class Eight

Class Nine

Class Ten

Medical History

Please provide dances medical details below

Do you have any allergies?*

Do you have any allergies?

Yes
No

Do you have a current Medical Condition?*

Do you have a current Medical Condition?

Yes
No

Do you have any current or previous injuries?*

Do you have any current or previous injuries?

Yes
No

Have you ever experienced a Fracture/Dislocation?*

Have you ever experienced a Fracture/Dislocation?

Yes
No

Have you ever experienced a Head/Neck/Spinal injury?*

Have you ever experienced a Head/Neck/Spinal injury?

Yes
No

Do you experience recurring Joint Pain with movement?*

Do you experience recurring Joint Pain with movement?

Yes
No

Do you wear Glasses/Contact Lenses?*

Do you wear Glasses/Contact Lenses?

Yes
No

Do you, or have you ever had, any of the following conditions?

Epilepsy
Diabetes
Asthma
Other Breathing Difficulties
Health Difficulties
Concussion
Hernia
Hepatitis A or B
Cancer

Additional Details

If you selected yes for any of the above please provide any necessary details below

Additional Medical Details

Primary Contact

First Last

Primary Phone

Primary Email

Secondary Contact

First Last

Secondary Phone

Secondary Email

Information and General Terms & Conditions

1. In the event of non payment of your fees, your membership will be terminated and your child's place given away. Please see the Director to discuss options if you are having financial difficulties.

2. In the event of any injury or illness to my child, I authorise the supervisors to apply or arrange first aid. I will pay all medical expenses incurred on behalf of my child.

3. I agree to release Danceworks 114 from any liability to my child or myself in relation to any injury or illness that my child may suffer, and for loss or damage to property, in connection with the activities, except to the extent that the liability arises as a result of the negligence of Danceworks114.

4. I understand that once fees have been paid they cannot be refunded.

5. I understand that Danceworks 114 is not a childcare service and is not responsible once the child has left/ finished their classes and/or the premises.

6. I understand that any customer or dancer over the age of 16 must check in via the QR code and show proof of vaccination upon entry to our facilities and wear a mask where applicable/ when required as per the Victorian Government mandate.

Consent*

I agree to the above terms and conditions

7. I understand that the teachers may wish to record images of the class, including images of children participating in activities. These images may be used in publications, events, promotional broadcasts, and websites in any form of media. This will also allow parents to have a visual image of their children’s progress.

Consent

I agree to the use of photos for promotional reasons

CAPTCHA

Resources

Apply online

Dancer One

Dancer Two

Dancer Three

Primary Contact

Secondary Contact

Information and General Terms & Conditions