Name of Student

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student DOB

Telephone Number

Alternative Tel number

Which class or style would you like to book?

Medical Conditions/Allergies

Please discuss any medical conditions with your child's teacher

Child's local education authority

How did you hear about us

Recommendation

Social media

Google

Workshop

Leaflet

Yell

Other

Please confirm below

I agree to keep the school updated with current emergency contact details and medical information

Social Media

I agree to my child’s photo being used publicly on social media

T & Cs

I accept I will be added to the email list and whatsapp broadcast list in order to receive communications from the dance school.

I confirm I have read and agree to all school policies

Or you can contact us via

Phone: 07909 336574

Email: principal@elainepygall.co.uk

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