Enrollment
Student Name (First) *
Student Name (Last) *
Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian *
Address *
Phone Number (Home)
Phone Number (Mobile)
Email *
I wish to enrol in (list all) *
Please choose one
Clear selection
Siblings enrolled
Emergency Contact Name *
Emergency Contact Number *
Check all that apply
Please list Medical or Health Conditions or any ongoing injuries
Please list previous dance experience
I have read and agree to 8Count terms and conditions *
Required
I am happy for 8Count to use images and videos
Images or video footage of students may be used for marketing and website / facebook purposes
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