warana ENCORE ENROLMENT FORM | Encore Performing Ar

Students First Name

Student DOB

Students Surname

Contact Number*

Email

Address

Student School Grade

Encore Age Group

Classes Selected:

Tick if you wish to be consider for:

Elite Performance Team

Does your dancer have any medical conditions we need to be aware of?

How did you hear about Encore

Facebook

Instagram

Google

Other

Referral

F45 BIRTINYA MEMBER

F45 SIPPY MEMBER

If referred by friends please list their name/s

Parent/Guardian Full Name