Registration/Signup Form ← BackThank you for your response. ✨ Student First Name(s)(required) Surname(required) Date of Birth (DD/MM/YYYY) (required) Age (under 18 only) Select one option 18 months 19 months 20 months 21 months 22 months 23 months 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Medical Conditions/Allergies/Injuries Previous Dance Experience (if any) how many years? Emergency Contacts Parent/Guardian (Adult Next of Kin)(required) Surname (required) Address (required) Email (required) Emergency Contact Number (required) Parent/Guardian 2 (adult classes not required) Surname (adult classes not required) Address (adult classes not required) Email (adult classes not required) Emergency Contact Number 2 (adult classes not required) Class/classes you want to enrol in: I offer one free class on initial trial. All under 18’s classes after that I ask for a terms commitment when deciding to sign up (approx 12 weeks) Ballet Ballet – Level 1- Mullion (Friday 15.45 – 16.45) Ballet – Level 1- Gweek (Saturday 9.00 – 9.45) Ballet – Level 2 Coverack (Monday 16.00 – 17.00) Ballet – Level 2 Mullion (Friday 16.45 – 17.45) Ballet – Level 2 Gweek (Saturday 10.30 – 11.15) Ballet – Level 3 The Lizard (Wednesday 16.00 – 17.00) Adult Ballet Coverack (Monday 18.00 – 19.00) Contemporary Contemporary Ages 8+ The Lizard (Thursday 17.00 – 18.00) Jazz/Musical Theatre Musical Theatre/Jazz ages 4-11 The Lizard (Thursday 15.45 -16.45) Jazz Ages 8+ Coverack (Monday 17.00 – 18.00) Jazz/Contemporary Ages 8+ Gweek (Saturday 12.00 – 13.00) Street/Commercial Junior Street/Commercial ages 8 – 11 Mullion (Friday 17.45 – 18.45) Junior Street/Commercial ages 8 + Gweek (Saturday 11.15 – 12.00) Senior Street/Commercial (Year 7+) The Lizard (Thursday 18.00 – 19.00) Yoga Yoga (Adult) Coverack (Monday 19.00 – 20.00) Tap Tap Ages 8+ The Lizard (Wednesday 17.00 -18.00) Adult Tap The Lizard (Wednesday 18.00 – 19.00) Choose several options Yes No Names of other children Adult classes Termly (10% off) (adult classes only) 'Pay as you go' (adult classes only) *Term times vary sightly from term to term. They are listed in the ‘Timetable’ section on the website but are usually around 11-14 weeks. Do you consent to the use of photography and videography of your child (or self) for performance social media and marketing purposes?(required) Yes No Do you wish to participate in our annual summer performance?(required) Yes No SubmitSubmitting form Δ
Miss Jarry's School of Dance