Student Registration Form
Student First Name *
Your answer
Student Last Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Parent / Carer's Name *
Your answer
Contact eMail Address *
Your answer
Contact Mobile Number *
Your answer
Alternative Contact Telephone Number
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1st Line of Address *
Your answer
2nd Line of Address
Your answer
Town *
Your answer
County *
Your answer
Postcode *
Your answer
Please list any medical conditions of which we need to be made aware
Your answer
Permissions - please tick boxes to give constent
EU Data Protection *
Required
How did you hear about Brookes Dance Academy?
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