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Central Coast Baby Ballet

CENTRAL COAST BABY BALLET

ENROLMENT FORM 2010

Please complete and return the document via email or post.

Postal:
89/44 Hutton Road
The Entrance North
2261
Email: ccbabyballet@gmail.com

Student’s family name Student’s given name/s


Known as (preferred name)
Male Female (please circle)
Age: Date of birth:

Parent/Carer
Family or Surname Given Name
Relationship to student
Address:
Home Phone: Mobile:
Email Address @

EMERGENCY CONTACT DETAILS


1. Contact Name: Telephone:
Relationship to student

2. Contact Name: Telephone:


Relationship to student

Doctor contact details


Name:
Address:
Doctor’s telephone:

Medical Conditions/Disabilities/Special Needs:

Please list ALL Adults who can collect your child after class.

Telephone: 4332 3885 mob: 0432 040 092


1
www.centralcoastbabyballet.com

email: ccbabyballet@gmail.com

Copyright © Central Coast Baby Ballet 2010.


Central Coast Baby Ballet

Photographs and Videos


Occasionally photographs and videos may be taken of individual students and
classes of students for promotional and/or media releases.
If you do not wish your child to be photographed or videoed under any
circumstances, please sign the statement below.

I do not wish my child to be photographed or videoed under any


circumstances.

Signature Date

FIRST AID / MEDICAL CONSENT


I consent for staff to administer basic First Aid, which will include band-aids,
bandages, soothing creams and antiseptic. In the case of emergency and a parent or
guardian are not present, staff will call an ambulance and contact the phone
numbers as indicated.

Signature Date

Applicant’s declaration
I declare that the information provided in this Enrolment Form is, to the best of my
knowledge and belief, accurate and complete.

I recognise that, should statements in this application later prove to be false or


misleading, any decision made as a result of this application may be reversed.
I have read and agree to abide by the Terms, Regulations and Policies stated by
Central Coast Baby Ballet.

Signature of applicant Date

Office use only


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DATE ENROLLED: CLASS ENROLLED:

Time: Location:

FEES: Term 1 Term 2 Term 3 Term 4

Costume Levy: Term 1 Term 2 Term 3 Term 4

Telephone: 4332 3885 mob: 0432 040 092


2
www.centralcoastbabyballet.com

email: ccbabyballet@gmail.com

Copyright © Central Coast Baby Ballet 2010.

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