Enrolment

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Alpha Dance Academy Enrolment Form

Ready to enrol? Please fill out the form below
and a member of Alpha Dance staff will contact you

Child's Details

Child's first name:

Child's surname:

Date of birth:

Address:

Home phone:

Parent's Details

Parent's/guardian's name:

Home phone:

Work phone:

Mobile:

Your Email:

Other Contact Details

Other contact's name:

Home phone:

Work phone:

Mobile:

Medical Details

Medical Conditions (for none, please type None):

Allergies (for none, please type None):

Current medication (for none, please type None):

Family doctor:

Doctor's Address:

Family Doctor's phone:

Terms and Conditions

By ticking this box you accept the terms and conditions

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