Enrolment Application
What Style of Dance:
Jazz
Hip Hop
Both
Please select what lessons you want to enroll for:
Recreational (one class per week)
Examination (two classes per week)
Competition (refer to terms & conditions)
*
First Name:
*
Last Name:
A value is required.
A value is required.
*
Date of Birth:
*
Email:
A value is required.
Invalid format.
dd-mm-yyyy
A value is required.
Invalid format.
*
Age of student:
Parent/Guardian Name:
A value is required.
Contact Numbers:
*
Home:
A value is required.
Work:
Mobile:
*
Address:
A value is required.
*
Suburb:
*
City:
A value is required.
A value is required.
Previous dance experience:
Yes
No
If yes please indicate experience and style below or make any other comments:
Please advise Day and Time of classes you wish to enroll into:
How did you hear about NWDA?
Local Paper
Recommended by Family / Friend
Internet
Flyer
Drove Past the Studio
Other
*
Please read Terms & Conditions
Yes I confirm that I have read and agree to the NWDA
Terms and Conditions
* = Compulsory Fields
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Nicola Wheeler Dance Academy
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