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INFINITY Gymnastics & Dance Adult Enrolment
Student Information
Email address *
Surname *
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First & Middle Names *
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Street Address *
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Suburb *
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Post Code *
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State *
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Mobile Phone Number *
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Age *
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Date of Birth *
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Gender *
Occupation *
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I am interested in the following classes *
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Have you discussed with a teacher/coach a suitable class and time for you to attend the centre? *
If yes, please confirm your suitable class style, day and time:
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Previous Experience *
Required
Length of time in previous training:
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Can the studio give out this information on a Contact List in your class level? *
Emergency Contact Persons Name *
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Emergency Contact Persons Mobile Phone Number *
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Relationship to you? *
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Alternative Emergency Contact Persons Full Name *
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Alternative Emergency Contact Persons Mobile Phone Number *
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Relationship to you? *
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Psychological and Medical Conditions *
Required
If yes, please provide more details:
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If anaphylactic or have an otherwise important medical condition, please provide a written medical plan below. A copy of a medical plan needs to be provided to the reception at the centre on commencement day.
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Medicare Number: *
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Private Health Insurer and Policy Number *
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In the event of an emergency, do you give the staff at Infinity permission to call an ambulance and/or administer first aid?
If No, please provide an alternative emergency plan...
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Can the studio use photography of you on social media, websites and for marketing purposes? *
Have you connected with us on Facebook and Instagram? *
How did you find out about Infinity Gymnastics and Dance? *
I have read, understood and agree with the Student Code of Conduct, Fee Policy, Safety Information and Other Rules and Recommendations as listed on the www.infinitygymdance.com.au website *
Full Name *
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Date *
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