ENROLMENT

Student Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Mobile Phone Number *

(###)

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Alternate Phone Number

(###)

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Name

First Name

Last Name

Phone Number

(###)

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Other Emergency Contact (Mobile)

(###)

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Permission (Emergency) *

In the event of illness or accident where the parent / guardian cannot be contacted, I authorise staff of The Jane Moore Academy of Ballet to refer my child to a doctor, hospital, or physiotherapist

I agree

Classes on Offer *

Please select the classes the student wishes to enrol in at the Academy. | * Please note not all styles are offered at all levels* |

Ballet

Jazz

Tap

Contemporary (Grade 4+)

Lyrical (Grade 5+)

Hip Hop (Grade 5+)

By ticking the box below, you have read and agreed to the School Policies.

Please find link to the School Policies Document at the top of the page.

I agree