Brighton Dance Academy Online Registration

Registration

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The form below is for all students wishing to enrol or trial at Brighton Dance Academy. Please note the form requires your payment method, however credit card details are optional.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Student's Last Name*

Where do you live?

Home Address*

City*

State*

Post Code*

Contact #1

First point of contact: First Name*

Last Name *

Relationship to student (for adults this is 'self')*

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

Second point of contact First Name*

Last Name*

Relationship to student*

How can we contact you?

Home Phone

Work #

Cell # *

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell #

Additional Info

Student Email

School*

Year Level at School*

Year First Enrolled at BDA*

Injuries (if n/a please leave blank)

Special Needs (if n/a please leave blank)

Allergies//Health Conditions (if n/a please leave blank)

Medications (if n/a please leave blank)

Preferred Pronouns

Concert Participation Y/N*

Please select any classes you wish to enrol in or trial. The 'Classes by Age Group' document will help you find relevant classes by year level at school. This can be found on our website.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell #

Additional Info

Student Email

School*

Year Level at School*

Year First Enrolled at BDA*

Injuries (if n/a please leave blank)

Special Needs (if n/a please leave blank)

Allergies//Health Conditions (if n/a please leave blank)

Medications (if n/a please leave blank)

Preferred Pronouns

Concert Participation Y/N*

Please select any classes you wish to enrol in or trial. The 'Classes by Age Group' document will help you find relevant classes by year level at school. This can be found on our website.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell #

Additional Info

Student Email

School*

Year Level at School*

Year First Enrolled at BDA*

Injuries (if n/a please leave blank)

Special Needs (if n/a please leave blank)

Allergies//Health Conditions (if n/a please leave blank)

Medications (if n/a please leave blank)

Preferred Pronouns

Concert Participation Y/N*

Please select any classes you wish to enrol in or trial. The 'Classes by Age Group' document will help you find relevant classes by year level at school. This can be found on our website.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell #

Additional Info

Student Email

School*

Year Level at School*

Year First Enrolled at BDA*

Injuries (if n/a please leave blank)

Special Needs (if n/a please leave blank)

Allergies//Health Conditions (if n/a please leave blank)

Medications (if n/a please leave blank)

Preferred Pronouns

Concert Participation Y/N*

Please select any classes you wish to enrol in or trial. The 'Classes by Age Group' document will help you find relevant classes by year level at school. This can be found on our website.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender*

Birth Date*

Cell #

Additional Info

Student Email

School*

Year Level at School*

Year First Enrolled at BDA*

Injuries (if n/a please leave blank)

Special Needs (if n/a please leave blank)

Allergies//Health Conditions (if n/a please leave blank)

Medications (if n/a please leave blank)

Preferred Pronouns

Concert Participation Y/N*

Please select any classes you wish to enrol in or trial. The 'Classes by Age Group' document will help you find relevant classes by year level at school. This can be found on our website.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

Payment Schedule*

Payment Method*

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Post Code

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank State Branch (BSB) Number (6-digit number)

Account Number

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Registration

Referral Information

Family Information

Where do you live?

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

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)