Registration Form

Please complete the form below to register for 2017 Classes. Fields with * are required to be completed.

*Surname:

*Given Names:

*Student Date of Birth:

*Address:

*Suburb:

*Postcode:

*Home Phone Number:

*Email:

Mother's Details

Mother's Name:

Mother's Mobile:

Occupation:

Father's Details

Father's Name:

Father's Mobile:

Occupation:

*Previous Dance Experience:

*Pre-School/School:

*Existing medical problems that could affect student's performance (Enter none if not applicable):

Family issues or situations you feel the dance school should be aware of (confidentiality assure):

Please select which class/s your child will be enrolled in (one for each class):

How did you find us?

Word of Mouth

Other

Additional Comments

*I acknowledge that I have read and agree to all the terms and conditions.

*I give unrestricted permission for RJ Performing Arts Academy to use video footage and / or photographs of my child/ward in print, video, and digital media.

This usage may include (but is not exclusive to) displaying publicly, distributing, or publishing, photographs, and/or video of my child for use in materials that include, but may not be limited to:

- printed materials (e.g. - brochures and newsletters)

- online and offline advertising and promotion

- videos and digital images such for use on Social Media.

I agree that these images may be used by RJ Performing Arts Academy for a variety of purposes and that these images may be used without further notification. I do understand that any identifying information including surname and location will not be used in conjunction with any video or digital images.

*I acknowledge that participation in dance is potentially dangerous and there is an inherent risk of injury involved.

In allowing my child to participate in RJ Performing Arts Academy activities, I hereby assume all the risks associated with the performing arts. I understand the importance of myself and my child following the instructions and rules set by their teacher/s, and I agree to release RJ Performing Arts Academy and its employees of any and all liability which may arise as a result of my child’s participation in activities at RJ Performing Arts Academy.

*Your Name: