KDA Online Registration Form
All Students must have a complete Registration Form on file before participating in classes with Kew Dance Arts. Your personal information will be kept confidential and used for internal purposes only.
Email address *
Your Details (Parent/Account Holder)
Please enter information about yourself
Your First Name *
Your answer
Your Surname *
Your answer
Home Address *
Your answer
Postcode *
Your answer
Phone Number *
Your answer
How did you hear about KDA? *
Student Details (Child)
Please enter information about your child
Student's First Name *
Your answer
Student's Surname *
Your answer
Student's Age *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Academic School *
Your answer
Current Year in School
Any allergies, special needs or medical conditions that we should be aware of? *
Your answer
Class Preferences
Please let us know which class(es) you would like to join
Term Time Classes on Mondays @ St Luke's House, Sandycombe Road TW9 3NP
Term Time Classes on Thursdays @ Pavilion Clubhouse, North Sheen Recreation Ground TW9 4LB
Free Trial Class (please tell us which class and on what date you would like to come)
Your answer
Waiver & Injury Release
Parent or legal guardian must sign for participants under 18 years of age. View KDA Terms & Conditions on our website; http://kewdancearts.com/kewdancearts.com/Registration.html
I have read and agree to comply with the KDA Terms & Conditions. Furthermore, I hereby release and indemnify Kew Dance Arts/Christine Ng or anyone teaching on her behalf of any and all liability, claims, and causes of actions arising out of our in any way connected with my/my child's participation. I authorize Kew Dance Arts/Christine Ng or anyone teaching on her behalf to seek emergency help and agree to allow any medical personnel the opportunity to treat an illness, injury, or any other medical condition. I agree to accept responsibility for any medical costs which may result from my/my child's participation. TO ACCEPT, PLEASE TYPE YOUR SIGNATURE BELOW; *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service