INFINITY Gymnastics & Dance SPRING 2018 Holiday Program Enrolment
Student Information
Email address *
Child's Surname *
Child's First & Middle Names *
Child's Age *
Child's Date of Birth *
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Gender *
Kinder/Primary/Secondary School Name *
I want to book for the following days: Please let us know if you have a small group of friends wanting an alternative date and we will do our best to run the program.
Full 8am-6pm $99
Half 8am-1pm $59
Wed 26 September
Thurs 27 September
Clear selection
My child is interested in the following activities: *
Required
You you interested in receiving information regarding our regular classes and programs? If yes, would you like to attend a free trial class at the commencement of the next term?
Previous Experience *
Required
Length of time in previous training:
Mothers Surname *
Mothers First Name *
Mothers Street Address *
Suburb *
Post Code *
State
Mothers Mobile Phone *
Mothers Email *
Fathers Surname *
Fathers First Name *
Fathers Street Address *
Suburb *
Post Code *
State
Fathers Mobile Phone *
Fathers Email *
Can the studio give out this information on a Parental Contact List in the child's class level? *
Marital Status *
Are there any court orders or parenting arrangements that we should be aware of? *
If Yes, please provide more relevant information *
Emergency Contact Persons Full Name *
Emergency Contact Persons Mobile Phone Number *
Relationship to the child? *
Alternative Emergency Contact Persons Full Name *
Alternative Emergency Contact Persons Mobile Phone Number *
Relationship to the child? *
Physiological and Medical Conditions *
Required
Please provide details:
If anaphylactic or have an otherwise important medical condition, please provide a written medical plan below. A copy of a medical plan needs to be provided to the reception at the centre on commencement day.
Medicare Number: *
Private Health Insurer and Policy Number *
In the event of an emergency, do you give the staff at Infinity permission to call an ambulance and/or administer first aid?
Clear selection
If No, please provide an alternative emergency plan...
Can the studio use photography of the child on social media, websites and for marketing purposes? *
Have you connected with us on Facebook and Instagram? *
How did you find out about Infinity Gymnastics and Dance? *
Fees and Payment
Payment must be made in order to secure a place in the program. Payment can be made via direct deposit.
Infinity Gymnastics & Dance : BSB: 033-060, Ac/N: 448 297. Reference: Child's Full Name. A remittance or proof of payment must then be sent via email to info@infinitygymdance.com.au following which a confirmation email will be sent to you.
Do you wish to receive a copy of the Student and Parents Code of Conduct? *
I understand and agree with the Student Code of Conduct and the centre Rules and Recommendations *
Full Name *
Date *
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