2026 KREATIONZ VAL PAL BOOKING FORM

MAIN ACCOUNT HOLDER DETAILS

The Main Account Holder is the person responsible for:
- Paying fees
- Receiving information
Account Holder Name*

First NameLast Name
Relationship to Student*
E-mail*
Mobile*
I am booking as a*

Non-MemberCurrent Student

STUDENT 1 DETAILS
Student 1 Name*

First NameLast Name
Gender*

FemaleMaleOther
Date of Birth*

DayMonthYear
Date
Current Age*
Please list any allergies, injuries, medications or medical conditions, including action to be taken (if applicable)
STUDENT 2 DETAILS (if applicable)
Student 2 Name

First NameLast Name
Gender

FemaleMaleOther
Date of Birth

DayMonthYear
Date
Current Age
Please list any allergies, injuries, medications or medical conditions, including action to be taken (if applicable)
STUDENT 3 DETAILS (if applicable)
Student 3 Name

First NameLast Name
Gender

FemaleMaleOther
Date of Birth

DayMonthYear
Date
Current Age
Please list any allergies, injuries, medications or medical conditions, including action to be taken (if applicable)

MEDICAL INFORMATION AND CONSENT
If Student 1, Student 2 or Student 3 has an Anaphalaxis or Asthma Management Plan, or any other relevant documentation please attach it here

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Medical Emergency Acknowledgement*

I acknowledge that in case of medical emergency, an ambulance will be called for my child/myself, if necessary.
Do you consent to Kreationz staff giving your child/ren a bandaid if necessary?*

YesNo
STUDIO LOCATION
Please select a studio location for your trial*

EmeraldFerntree GullyYarra Valley

TERMS AND CONDITIONS

In order to commence classes with Kreationz Dance, the Terms and Conditions must be read, understood and agreed to.

The Trial Booking Terms and Conditions can be downloaded here.
Please sign here to indicate your agreement to the Terms and Conditions*

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Comments
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