Request edit access
INFINITY Gymnastics & Dance Child Enrolment
Student Information
Email address *
Child's Surname *
Your answer
Child's First & Middle Names *
Your answer
Child's Age *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Gender *
Kinder/Primary/Secondary School Name *
Your answer
I am interested in the following classes: *
Required
Have you discussed with a teacher/coach a suitable class and time for your child to attend the centre? *
If yes, please confirm your suitable class, style, day and time:
Your answer
Previous Experience *
Required
Length of time in previous training:
Your answer
Mothers Surname *
Your answer
Mothers First Name *
Your answer
Mothers Street Address *
Your answer
Suburb *
Your answer
Post Code *
Your answer
State
Your answer
Mothers Mobile Phone *
Your answer
Mothers Email *
Your answer
Fathers Surname *
Your answer
Fathers First Name *
Your answer
Fathers Street Address *
Your answer
Suburb *
Your answer
Post Code *
Your answer
State *
Your answer
Fathers Mobile Phone *
Your answer
Fathers Email *
Your answer
Can the studio give out this information on a Parental Contact List in the child's class level? *
Marital Status *
Are there any court orders or parenting arrangements that we should be aware of? *
If Yes, please provide more relevant information *
Your answer
Emergency Contact Persons Full Name *
Your answer
Emergency Contact Persons Mobile Phone Number *
Your answer
Relationship to the child? *
Your answer
Alternative Emergency Contact Persons Full Name *
Your answer
Alternative Emergency Contact Persons Mobile Phone Number *
Your answer
Relationship to the child? *
Your answer
Physiological and Medical Conditions *
Required
Please provide details: *
Your answer
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.
Your answer
Medicare Number: *
Your answer
Private Health Insurer and Policy Number *
Your answer
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...
Your answer
Can the studio use photography of the child 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 www.infinitygymdance.com.au *
Full Name *
Your answer
Date *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service