2021 YVB Summer Program, Student Enrolment Form (18+ years)
Email address *
Section 1 - Student Information
Student Name *
Student Date of Birth
Contact Number/s *
Emergency Contacts
1. Name, Relationship, Contact Number *
2. Name, Relationship, Contact Number
Dance Background / Information
Previous Dance Experience *
Medical Information
Please advise any allergies or medical information of which we should be aware *
Please advise any injuries, minor or major, that may affect your ability to participate in classwork *
Student Safety Policy & Injury Liability Waiver
Yarra Valley Ballet subscribes to the Ausdance Safe Dance Practice Guide, available at: http://ausdance.org.au/articles/details/safe-dance-practice.

Student safety is of utmost importance at Yarra Valley Ballet. Alongside physical and environmental safety, we encourage and promote mental and emotional well being which includes a balanced approach to training, healthy eating habits, and fatigue and injury management.

Whilst every effort is made to manage and mitigate risk, accidents can happen. In the event of an injury, we recommend students seek medical advice from a qualified professional. YVB staff will work alongside the student and family to facilitate rehabilitation and re-integration to classes.


We agree that we will not hold Yarra Valley Ballet Pty Ltd or any of its Directors liable for injuries sustained in the normal course of dance class activity.
Please indicate your agreement to the above Injury Liability Waiver *
Visual Media Policy
From time to time YVB teachers may take photos and/or video footage of students during class time. This media is used for educational purposes only and may be shared with enrolled families of the class and/or YVB staff.

Photographs and/or video footage may also be taken during theatre rehearsals and performances and may be shared with the YVB community through email and/or our closed Facebook page (ie not the public page).

If we wish to use any images or footage publicly, we will seek your express written consent where the image or footage visually identifies you. Public use may include our website, public Facebook page, or advertising materials.
Please indicate your agreement to the above policy *
Fee Policy
All Summer Program Fees must be paid prior to class commencement.

Our preferred payment methods are cash or direct deposit.
Yarra Valley Ballet Pty Ltd | 013 278 | 224433446

We offer a 100% refund for:
• student who cannot continue for medical reasons supported by a doctor's certificate
• for all future scheduled classes only.

We do not offer refunds for classes that have already been taken, or retrospective classes missed due to illness/injury/choice/circumstance.
Please indicate your agreement to the above policy *
How did you hear about Yarra Valley Ballet? *
Is there anything else you would like to advise or discuss?
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