2018 Enrolment Form

The information requested on the form is essential for assisting us to plan for the support of your/your child’s health needs and communication methods. It will be used by Vital Movement Studios only. If you do not provide all or any of this information, the studio’s capacity to support your/your child’s health needs could be impaired. This information will be stored securely. You may correct any personal information provided at any time by filling in another enrolment form that can be printed off our website. It is your responsibility to ensure a new form is filled out should your contact or medical information change.

PLEASE FILL OUT EVERY SECTION OF THIS FORM

Student's Name *
Student's Name
Student's Address *
Student's Address
Parent/Carer 1 Name *
Parent/Carer 1 Name
Parent/Carer 1 Address *
Parent/Carer 1 Address
Parent/Carer 2 Name
Parent/Carer 2 Name
Parent/Carer 2 Address
Parent/Carer 2 Address
Emergency Contact 1 *
Emergency Contact 1
If parent/carer is unavailable
Emergency Contact 2
Emergency Contact 2
Jazz Classes
Please select the Jazz classes you/your child would like to enrol in
Tap Classes
Please select the Tap classes you/your child would like to enrol in
Ballet Classes
Please select the Ballet classes you/your child would like to enrol in
Hip Hop Classes
Please select the Hip Hop classes you/your child would like to enrol in
Contemporary Classes
Please select the Contemporary classes you/your child would like to enrol in
Acrobatic Classes
Please select the Acrobatic classes you/your child would like to enrol in
Cardio Barre Class
Please select the Cardio Barre classes you/your child would like to enrol in
Medical
Please select if you/your child suffer from any of the following
If you selected any of the above please give details I.e. severity of condition, frequency of medication
Consent *
I understand that some physical contact may be necessary by a staff member to demonstrate exercises or technique during classes. I accept that Vital Movement Studios trained staff will administer first aid and/or call emergency services in the case of any accident or injury during class, and that I will be sent any subsequent medical bills. I understand that dance classes can involve risk of personal injury. While Vital Movement Studios takes all reasonable care in the conduct of its classes, it accepts no responsibility for injuries sustained during dance classes.
Publicity Consent *
I give permission for photos and videos of myself/my child to be used for advertising by Vital Movement Studios only. This includes studio newsletters, website, social media (Facebook, Instagram, Snapchat) & print advertisements
Correspondence *
I am happy to receive invoices and newsletters via email
How did you find us? *
Declaration *
I admit to the information given as being true and correct and take full responsibility for any incident arising where information has been with-held. I understand that I am required to pay my account for all tuition undertaken at Vital Movement Studios, and have read & agree with the fee policy as stated in the 2018 VMS Information Pack.
Electronic Signature *
Electronic Signature
I consent to electronic enrollment. By placing my name in the box below, I acknowledge that I am signing this agreement and warrant that I am authorised to sign.