MSDC Dance Youth Company Enrolment & Medical Form

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This form provides MSDC Dance Tutors with the adequate and necessary information needed to support MSDC Dance Youth Company members. On completing this form, you are confirming that the young person you are enrolling will commit to attending the weekly classes, will follow the class code of conduct and will be travelling to the venue either independently or accompanied by an adult.

Full name of Student *

Please state student's Date of Birth *

YYYY

Does this student have any known medical history or additional needs we should be made aware of? *

Yes

Please provide a short description of any medical or additional needs the student has *

What is the relation of the emergency contact to this student? *

Please provide the name of the emergency contact for the student *

Please provide the contact number for the emergency contact *

What is the email address for the emergency contact? *

In the event of an accident involving this student, I give consent for a member of MSDC Dance to obtain medical assistance/advice for the administration of any necessary treatment *

Yes, I consent.

No, I do not consent.

Required

Please let us know how the young person named will leave the sessions (If this changes - please advise Megan and Danni via email msdcdance@yahoo.com) *

They will attend the sessions independently and leave independently (suchas walk or using public transport)

They will leave with an adult who will sign them out.

Required

Signature of Parent/Guardian *

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