Theatre De La DanSe Online Registration

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Theatre De La DanSe

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Additional Info

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

Contact #1

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Confirm Email*

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Contact #2

First Name*

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Cell # *

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Confirm Email

Student #1

Student's First Name*

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School*

Year Level at School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

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Epipen user - Yes or No?*

Please contact the office info@tdld.com.au if you're not sure which class to select.

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Student #2 (Show-Hide Details)

Student's First Name*

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Additional Info

Student Email

School*

Year Level at School*

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Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Epipen user - Yes or No?*

Please contact the office info@tdld.com.au if you're not sure which class to select.

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Student #3 (Show-Hide Details)

Student's First Name*

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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?*

Please contact the office info@tdld.com.au if you're not sure which class to select.

Enroll in Classes

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Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

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?*

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*

Cell #

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?*

Please contact the office info@tdld.com.au if you're not sure which class to select.

Enroll in Classes

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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

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Student #2 (Show-Hide Details)

Additional Info

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Student #3 (Show-Hide Details)

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Questions or Concerns

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Required Policies

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