Holiday Classes Enrolment Form
Student Details
Student Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Student age:
*
Medical Conditions/Allergies
*
Contact Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Dates attending
*
Please Select
Wed 23 Sept (only)
Mon 28 Sept (only)
Both 23 & 28 Sept
Name of current Ballet School/Academy
*
Director's Name
*
First Name
Last Name
Ballet School/Academy Email
*
example@example.com
Are you an aspiring professional ballet dancer?
*
YES
NO (I do ballet recreationally)
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Parent/Guardians Information
Parent/ Guardian's Full Name
*
First Name
Middle Name
Last Name
*
Parent
Guardian
Relationship to student
*
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Other information
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Student Medical Information
Allergies
*
Medical Conditions
*
Current Medications
*
Additional Information
Does the student have any special needs or accommodations?
*
(if YES, please list)
Is there any additional information that we should know?
*
CONSENT AND RELEASE
I hereby authorize the staff of Ballet Express to act on my behalf in case of an emergency involving the student listed above. I understand that every effort will be made to contact me or the emergency contact listed above, but in the event that neither I nor the emergency contact can be reached, I give my consent for Ballet Express staff to seek emergency medical treatment for the student. I release Ballet Express and its staff from any liability in connection with the treatment of the student in case of an emergency.
Parent/Guardian Signature:
*
Date signed
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Holiday Classes 2026
*
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( X )
AUD
X1 Class $66 (incl GST) | X2 Classes $132 (incl GST)
Payment Methods
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
Submit
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