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© Copyright 2006-2010 Balmain Dance Academy
Date of Birth (DD.MM.YYYY)*
Parents/Guardians Name(s)*
   
Home Address *
Suburb *
Postcode *
Home Phone *
   

Please indicate which classes you
are enrolling in:

   
Are there any medical conditions which should be known about?
If yes, please list:
I give permission for my child to receive medical treatment, if necessary.
I undertake to pay the term's fees within 14 days, or incur an extra accounting fee of $10.00 if not fully paid within 3 weeks of due date, and an additional fee of $10.00 if not fully paid by the end of term.
 
All cheques to be made payable to "Balmain Dance Academy"
Direct Deposit Details available on request.