Adult Registration Form

Please fill-in all sections of this form in as much detail as possible

BEFORE your first class

1. Personal Details:

First Name

Date of Birth

Postcode

Home Phone

Last Name

Address

Mobile Phone

2. Emergency Details:

Name of Emergency Contact (1)

Relationship to Child (1)

Telephone Number (1)

Name of Emergency Contact (2)

Relationship to Child (2)

Telephone Number (2)

3. Additional Information:

Do you have any disabilities and/or medical needs that CSD ought to know about?:

I accept and understand that the teaching of dance can involve teachers having physical contact with me. I consent to this: (Please initial/sign)

Photographs are sometimes taken by press and/or CSD for our ongoing website gallery and other promotional documents. I give permission for this: (Please initial/sign)

How did you hear about CSD?

Signature

Date

Thank you for submitting!

N.B. If you have queries/concerns regarding any of the above, don’t hesitate to contact us via any of the means listed on our Contact page. By signing this form, you consent to CSD being able to contact you with any and all pertinent information. Your information/details will not be passed on to any third party.