Melbourne Studio of Ballet - 2021 - Student Enrolment (required)
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1. First Name (Parent/s) *
2. Last Name (Parent/s) *
3. Street Address *
4. Street Address (Line 2)
5. City *
6. State *
7. Post Code *
8. Phone Number *
9. Email Address *
10. Student's First Name *
11. Student's Last Name *
12. Student's Birth Date *
13. Female / Male *
16. How did you hear about Melbourne Studio of Ballet?
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18. Primary Emergency Contact Name: *
19. Primary Emergency Contact Relationship *
20. Primary Emergency Contact Phone Number: *
xxx-xxx-xxxx
32. Asthma?
33. If "Yes", please describe
34. Allergies?
35. If "Yes", please describe
36. Medications?
37. If "Yes", please describe
38. Does the student have any medical condition that may impact his/her ability to participate safely during ballet classes that the Melbourne Studio of Ballet should be aware?
Melbourne Studio of Ballet - Release of Indemnity & Liability, Photography Permission & No Refund Payment Policy
a. I understand that my participation (or that of my daughter/son) in ballet classes and training is a physically demanding activity where injuries from time to time may occur. My decision for myself (daughter/son) to participate is made by me in full recognition of these risks. I represent that I/daughter/son am/are in adequate physical condition to participate in ballet classes and that I will inform the Melbourne Studio of Ballet of any previous or exsisting injuries before commencing. In consideration of my submission of this enrolment, I hereby agree to release Melbourne Studio of Ballet of all liability on account of any injury, loss, claim or damage to my/daughter/son's health, well-being or property during my participation of all class and associated activities with Melbourne Studio of Ballet.
b. I give permission for myself, daughter/son to be photographed for promotional purpose at the discretion of the Melbourne Studio of Ballet.
c. No refund will be given for any booking or payments of fees made throughout the year.

I have read and understand the above
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