Balmain Dance Academy

Child's Name *
Age *
Date of Birth (DD.MM.YYYY)*
Parents/Guardians Name(s)*

Home Address *
Suburb *
Postcode *
Home Phone *
Email Address *
Mobile Number

Please indicate which classes you are enrolling in:

Are there any medical conditions which should be known about?	Yes No
If yes, please list:
I give permission for my child to receive medical treatment, if necessary.	Yes No
I undertake to pay the term fees within 14 days. I understand that fees paid within 14 days will receive a discount. I understand that fees paid after 4 weeks will incur an additional accounting charge.
I understand that my child will receive a minimal amount of physical correction to his or her technique as part of the class.


All cheques to be made payable to "Balmain Dance Academy" Direct Deposit Details available on request.