1. No category

INFORMATION ABOUT YOU
Your name: ______________________________________________________________________
Address: ________________________________________________________________________
_______________________________________
Postcode: _______________________________
Telephone Number ________________________ Alternative Number: _______________________
E-mail: __________________________________________________________________________
Where did you hear about us: ________________________________________________________
INFORMATION ABOUT YOUR CHILD(REN)
Name
D.O.B.
Age
Any other issues you would like us to be aware of (Medical issues, allergies etc.)
EMERGENCY CONTACT
This should be someone we can contact on your behalf should a problem arise in class.
Name: __________________________________________________________________________
Relationship to the child: ____________________________________________________________
Address: ________________________________________________________________________
_______________________________________
Postcode: _______________________________
Contact Number ________________________
Alternative Number: _______________________
If you wish to add another Emergency Contact please feel free to do so on the back.
I understand that children attending these sessions must be accompanied by and remain the
responsibility of their parent or guardian at all times.
Signed:____________________________________
Relationship to the child(ren): ____________
Date:_______________________________
Please note this information is used only by Dance Sacks, we don’t share information with any third parties.