Adult Enrolment form
Pepa Molina Flamenco Dance Academy enrolment form.
Please fill in the the questions marked with an *
Timetable, fees & more info: https://www.pepamolina.com/flamenco-dance-classes-sydney/ 
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Email *
Name *
Surname *
Date of Birth *
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/
DD
/
YYYY
Mobile Number *
Address *
Do you have any previous Flamenco dance experience? Or any other dance background? *
What classes would you like to enrol in? *
Required
Consent for using photos or videos from classes or performances on our social media/ Website or other
Please choose below
 *
Where did you here about us?
 *
Enrolment fee

*Enrolment fee of $40 (for new students)
Direct deposit to account to secure your place by due date 17/1/24
Payment details:
Bank details for transfer;
Account name: Josephine Perez
Bank: Commonwealth Bank.
BSB: 062334 Account No: 11264083
Reference your name.
Please email remittance to:
info@pepamolina.com
 *
How will you be paying enrolment fee?
 *
Emergency contact number (Other than your own)
 *
Do you have any medical conditions? If so please specify
 *
Family Doctor (Phone number)
 *
Person consenting this enrolment
 *
A copy of your responses will be emailed to the address you provided.
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