Give into Dance - North London Street Dance Class
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Give into Dance - North London Street Dance Class


Please complete the form below. Your completed form will be presented to you at your first 'Give into Dance' class to sign and date where prompted below.


Personal Details
First Name: *
Surname: *
Sex:
Male  Female  
Your Age:
Address:
Telephone No:
Mobile No:
Email Address: *
Dance Experience:
A first timer  Beginner  Intermediate  Advanced  


Medical Information
Do you have any medical condition(s) that we should be aware of?
No  Yes  
If 'Yes' please give brief details:


Emergency Contact Details
Emergency Contact Name: *
Relationship:
Contact number: *


Press & Publicity Consent
I Consent to photographs, video or film footage of me to be used only by 'Give into Dance' as marketing material. All information provided on your application form is private and confidential, personal details will not be divulged:
Yes  No  
How did you hear about us:
Date:
Signature required once form is printed:


Parent / Guardian Consent (Only required if under 16 years old)
I hereby give consent for my son/daughter to take pat in 'Give into Dance' lessons:
Yes  No  
Parent/Guardian Name:
Relationship to student:
Signature of Parent/Guardian required once form is printed:
Date


Now press 'Send' to register. Your form will be waiting for you at your first 'Give into Dance' class to sign and date. Thank you!
Give into Dance, North London Dance Classes