Theatre De La DanSe Online Registration

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Theatre De La DanSe

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Referral Information

How did you hear about us?*

Family Information

Last Name*

Where do you live?

Home Address*

City*

State*

Postal Code*

Home or Primary Phone*

Additional Info

Emergency Contact Info - Please list someone other than you and their contact number*

Contact #1

Parent/Guardian First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

First Name*

Last Name*

Type*

How can we contact you?

Home Phone

Work #

Cell # *

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=dd/mm/yyyy)

Additional Info

Student Email

School*

Year Level at School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Epipen user - Yes or No?*

Vax status 12yrs+ Yes or No?

When enrolling in a class please ensure you select the correct class based on age. Please contact the office info@tdld.com.au if you're not sure which class to select.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=dd/mm/yyyy)

Additional Info

Student Email

School*

Year Level at School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Epipen user - Yes or No?*

Vax status 12yrs+ Yes or No?

When enrolling in a class please ensure you select the correct class based on age. Please contact the office info@tdld.com.au if you're not sure which class to select.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=dd/mm/yyyy)

Additional Info

Student Email

School*

Year Level at School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Epipen user - Yes or No?*

Vax status 12yrs+ Yes or No?

When enrolling in a class please ensure you select the correct class based on age. Please contact the office info@tdld.com.au if you're not sure which class to select.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=dd/mm/yyyy)

Additional Info

Student Email

School*

Year Level at School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Epipen user - Yes or No?*

Vax status 12yrs+ Yes or No?

When enrolling in a class please ensure you select the correct class based on age. Please contact the office info@tdld.com.au if you're not sure which class to select.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=dd/mm/yyyy)

Additional Info

Student Email

School*

Year Level at School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Epipen user - Yes or No?*

Vax status 12yrs+ Yes or No?

When enrolling in a class please ensure you select the correct class based on age. Please contact the office info@tdld.com.au if you're not sure which class to select.

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

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Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

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Questions or Concerns

Required Policies

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