DAPA STUDENT ENROLLMENT FORM
Please complete all sections in this form.
PERSONAL DETAILS
Full Name of Student *
Your answer
Date of Birth *
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School or Work Place
Your answer
Address *
Street No.; Street Name; Street Type; Suburb; Postcode; State
Your answer
Telephone *
Your answer
Mobile *
Your answer
Email *
Your answer
Gender *
Your answer
Special Needs *
Please list any allergies, health conditions or special needs
Your answer
PARENT / GUARDIAN INFORMATION
Full Name *
Your answer
Place of Work
Your answer
Occupation
Your answer
Telephone (Residence) *
Your answer
Telephone (Office)
Your answer
Mobile *
Your answer
Email *
Your answer
Address *
Your answer
EMERGENCY CONTACT
Emergency Contact 1 - Name *
Your answer
Emergency Contact 1 - Telephone *
Your answer
Emergency Contact 1 - Mobile *
Your answer
Emergency Contact 1 - Email *
Your answer
Emergency Contact 2 - Name *
Your answer
Emergency Contact 2 - Telephone *
Your answer
Emergency Contact 2 - Mobile *
Your answer
Emergency Contact 2 - Email *
Your answer
PROGRAMMES
Which Programme(s) are you enrolling for? *
You can choose more than one provided you meet the eligibility criteria (e.g. age)
Required
FAMILY RATES
Special rates apply when you have family members also in the school. Please provide details for anyone in your immediate family that also attends our classes. Special rates do not apply for solo lessons ad masterclasses.
1. Name of parent/child/sibling also attending
Your answer
Programme attended
Your answer
2. Name of parent/child/sibling also attending
Your answer
Programme attended
Your answer
3. Name of parent/child/sibling also attending
Your answer
Programme attended
Your answer
4. Name of parent/child/sibling also attending
Your answer
Programme attended
Your answer
PAYMENTS
Select the rate you will be paying *
Please see our website for the prevailing fee or provide the relevant promotional item to confirm eligibility for the Promotional Rate. Not sure which one applies? That’s not a problem, we will be in touch with you if you have selected the incorrect rate and either refund the excess, or send an invoice for the remainder. Please also tick the "Introduce-a-Friend" box in the next question if you are eligible for this rebate.
Please also tick the "Introduce-a-Friend" box if you are eligible for this rebate.
If you introduce a friend later, you will become eligible for this rate for that term.
Name of friend introduced
Your answer
Registration Fee Payable *
Please see our website for the prevailing fee or provide the relevant promotional item to confirm eligibility for the Promotional Rate. Not sure which one applies? That’s not a problem, we will be in touch with you if you have selected the incorrect rate and either refund the excess, or send an invoice for the remainder.
Payment Method *
Please indicate how you would like to pay the enrollment fee and the relevant term fee. If you choose to use EFT or Bank Deposit, please provide us with a copy of the payment receipt. Enrollment will only be processed once both the completed form and payment confirmation are received. BANK DETAILS: ANZ Livingston | Name: DAPA Australia | Account: 016-318 3953-08519. NOTE: **Your payment reference should be the student's last name followed by the last two digits of the year and the term number. For example if Jane Doe is paying for term 1 2015, your narration would read: Doe151
How did you find out about DAPA? *
Required
If you chose "Other" above, please provide detials
Your answer
If you were referred to DAPA by a friend or one of our students please provide their name
Your answer
PHOTOGRAPH POLICY
We sometimes use photographs taken during class for our website, internal newsletter, newspaper articles and display purposes. Please be informed that if your permission is not given for photographs we will not be able to take photographs during special events. We also often take short video clips of our classes and have complete video coverage of our shows. Photographs and videos are never used without your permission. Refer the Student Handbook to find out about our policy on photo and videography.
Please check the relevant box to let us know whether you are comfortable with photo and video coverage of our programmes and shows. *
ABOUT YOU
Tell us a little about you interests, goals and ambitions:
Your answer
ACCEPTANCE AND CONFIRMATION
Clicking your acceptance below confirms this submission (subject to receipt of payments due) *
Please note, enrollment cannot be processed without completion of this section.
Date of Acceptance *
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