ENROLMENT - Madeline Stuart Dance Company

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Registration

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Applicant Details

Age of student - DOB*
Postal address:*

Name & number of Contact person or next of kin

What classes are you interested in? Tick as many as you like and please place numbers 1-5 in the box, 1 means most interested, 5 is least interested. We will add you to the roll from venues above and interest, after completing your trial please contact us via phone or email to confirm which classes you would like to continue or if you decide you do not want to continue so we can update our system*
Media Information:

Access Requirements

Do you have any medical, disability, dietary, welfare, wellbeing or access requirements you would like us to be aware of?*

In case of Emergency

In case of emergency, I give permission for appropriately trained persons to administer medical treatment. Incase of such an emergency, please contact;

Support Worker

If you need to be accompanied by a support worker please give the person’s name and contact details here. There will be no charge for a support worker to accompany you.
Will you be paying with NDIS?
If you are a plan manager we will send invoices to YOU and your NDIS provider, please supply name of plan manager and email address
I realise that my enrolment will not end until I notify Inside Outside Dance that I do not want to attend classes anymore by email.*

Further Information

Madeline Stuart Dance Company looks forward to working with you.

If you have any questions please email Rosanne at - dance@insideoutsidedance.com
or phone on 0428 156 688,

Madeline Stuart Dance Company

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