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Child’s Name

Child’s Date of Birth

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Medical Details (e.g. allergies, previous/current injuries, disabilities, medication required etc.)

Child’s address:

Does your child have any previous dance experience? If so, please provide details below

Parent/Guardian’s Name

Parent/Guardian’s Email

Emergency Contact Number 1

Emergency Contact Number 2 (please provide an alternative)

Which class or classes are you interested in?

Do you give permission for Espoir School of Dance to photograph/video your child and for these images and footage to be used on social media?(required)

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How did you hear about us?

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