Enrolment Form For Adult Students (Music)

Type of Lesson 1 *

Type of Lesson 2 *

Student's Name *

First

Last

Date of Birth *

(dd/mm/yyyy)

Address *

Emergency contact (Name) *

First

Last

Relationship to Student: *

Telephone # *

Email Address *

Email

Confirm Email

Please give details of any Dance/Music background *

Do you give permission to be shown in promotional media photos or videos? (please choose) *

Any known medical conditions/allergies/special needs/disabilities: *

I give permission to be given emergency medical treatment (please choose) *

How did you find M & L School of Performing Arts? *

Disclaimer: I am aware that participating in dance involves inherent risks and hazards. I freely accept and fully assume all such risks, dangers, and hazards and the possibility of personal injury. I authorize M & L School of Performing Arts to seek medical services in case of serious injury or illness. I understand that M & L School of Performing Arts employees and/or contractors will not assume responsibility for any lost or stolen property, or for any bodily or personal injury consisting of or arising out of any participation in any physical training. *

Please tick

Date *

(dd/mm/yyyy)

Name: *

First

Last

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