Dancer Details

First name

Last name

Birthday

Day

Month

Year

Please select the classes you would like to trial.

Do you.your child have any existing illnesses/allergies/health conditions etc? If so, please describe including details about medication, inhalers or care that you/your child may need to receive during their time with us.

Parent/Guardian Details

If you are an adult dancer, please fill in the following section with your contact details.

Name

Email

Phone

Emergency Contact Details

Contact Name

Relation to Dancer

Phone

Consent

I give consent for me/my child to be filmed or photographed in class/shows for marketing purposes. (Including social media and print)

I Consent

I Do Not Consent

I agree to Momentum School of Dance storing my submitted information in order to respond to my enquiry.

I agree to the Momentum School of Dance terms & conditions.

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Dancer Details

Parent/Guardian Details

Emergency Contact Details

Consent