Performer's Name *

First Name

Last Name

Performer's Date of Birth

MM

DD

YYYY

Classes Trialling *

Tick all applicable

Junior Dance (Monday 4.30pm)

Wheels (Monday 5.15pm)

Musical Theatre/Tap (Monday 6pm)

Hip Hop (Monday 7pm)

Junior Ballet/Jazz (Wednesday 4.30pm)

Junior/Intermediate Acting/Physical Theatre (Wednesday 4.30pm)

Senior/Intermediate Dance (Wednesday 5.15pm)

WeMove Fitness (Wednesday 6pm)

Singing (Wednesday 6.45pm)

Date of Trial *

MM

DD

YYYY

First Aid *

Please tick yes or no to consent to Emergency First Aid treatment if required and as deemed necessary (including calling an ambulance if required).

YES

NO