Enrolment Form

Complete the form below to join Fortitude Dance Works

Full name of pupil/student:

First Name

Last Name

Pupil/student DOB:

Address of pupil

(over 18 only- under 18’s please complete emergency contact details below)

Phone Number

Email Address

Does the pupil/student have any medical history we need to be aware of? i.e injury, long term illness, medication, allergies etc:

Emergency contact - Name:

Emergency contact - Address

Emergency contact - Mobile Number

I confirm that I have read this document, and that the above information is correct to the best of my knowledge. I will inform Fortitude Danceworks of any change in my circumstances. I consent to my information being held by Fortitude Danceworks/Emma Allin (Principal) only.

I confirm

Signature Agreement

This is your signature agreement to the document above. For 18+ students please leave your name below. If this form is for a student below the age of 18 please sign here as the parent/guardian.