Enrolment Form 2015 - Casey Priddle Dancers

 Student Name: _______________________________________________________________________
Student Address:______________________________________________________________________
Post Code: __________ Student Home Phone: _______________ Student Mobile: __________________
Email Address:________________________________________________________________________
(CPD Information only)
Birthdate: ____________________________ Age as 01/01/15: ________________________________
Year / Date commenced at CPD: ___________
Other Siblings dancing at CPD ____________________
Parent / Guardians:_______________________
Parent / Guardian Contact No: ___________________
Emergency Contact Name & No: _________________________________________________________
(Must be different from above)
Relevant Medical Conditions/Injury:
___________________________________________________________________________________
____________________________________________________________________________PTO___
Please list the classes you wish to participate in:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
____________________________________________________Total hours per week:_____________
PLEASE READ BELOW & SIGN ALL RELEVANT CLAUSES:
Photography & Videoing may be used during class, at competitions and events throughout the year. I am
aware that my son/daughter may be featured and this may be used for promotional advertising and/or
maybe displayed in the studio or at the concert.
SIGN _________________________________________ DATE: ___________________________
In the event of an emergency an ambulance shall be called & any costs incurred are not covered by Casey
Priddle Dancers.
SIGN _________________________________________ DATE: ___________________________
Troupe class students will be required to participate in competitions some weekends and during the school
holidays.
SIGN _________________________________________ DATE: ___________________________
I have filled in all details above correctly and have read and understand all information in the CPD
Information Booklet 2015.
SIGN _________________________________________ DATE: ___________________________