CROMER DANCE STUDIO

Enrolment Form

Student Name *
Student Name
Date of Birth *
Date of Birth
Parent / Guardian's Name *
Parent / Guardian's Name
Home Address *
Home Address
Emergency Contact Name *
Emergency Contact Name
Conditions of Enrolment
01. Student is enrolling until end of the current year. 02. PGNS is divided into four terms (term duration may differ). 03. Fees are charged each term (not each week) and are payable in ADVANCE for the full term. 04. Prior to each term PGNS will issue an invoice for all applicable fees and GST. 05. Fees are due and payable within 7 days of the term commencing. 06. Enrolling families must provide credit card details on this enrolment form. 07. Fees unpaid after 7 days of the term commencing will be debited from the credit card provided 08. PGNS reserves the right to refuse admission to any students whose fees remain unpaid after 7 days of the term commencing. 09. If you chose to pay by cheque, please note that if there are insufficient funds in the account, you will be charged a dishonour fee. 10. PGNS has a no refund policy for missed classes. 11. Student is permitted to withdraw from any class during the year providing written notice of withdrawal is received by PGNS 
at the end of term. PGNS will continue to invoice you for each term until you have informed us of your withdrawal. 12. Please note as dance is a physical activity, a degree of physical contact between teacher and student may be require for either demonstration or correction. 13. Dancing is a strenuous activity from which injuries could arise. PGNS and the instructors are NOT LIABLE for personal injuries, loss of, or damage to personal property. 14. Please inform instructor of any physical limitations you may have.
Health Information and Medical Release/Waiver
I, acknowledge that participation in dance is potentially dangerous and there is an inherent risk of injury involved. In allowing my child to participate in Plié, Groove’n’Shuffle activities, I hereby assume all the risks associated with the performing arts. I understand the importance of myself and my child following the instructions and rules set by their instructor/s, and I agree to release Plié, Groove’n’Shuffle and it’s employees of any and all liability which may arise as a result of my child’s participation in activities at Plié, Groove’n’Shuffle.
Parent Release Form for Photography and Videography
I, the undersigned, give permission for Plié, Groove’n’Shuffle to use video footage and / or photographs of my child/ward. This usage may include (but is not exclusive to) displaying publicly, distributing, or publishing, photographs, and/or video of my child for use in materials that include, but may not be limited to: - printed materials (eg - brochures and newsletters) - online and offline advertising and promotion - videos and digital images such for use on Social Media. By signing this form, I acknowledge that I am giving unrestricted permission for my child’s image to be used in print, video, and digital media. I agree that these images may be used by Plié, Groove’n’Shuffle for a variety of purposes and that these images may be used without further notification. I do understand that any identifying information including surname and location will not be used in conjunction with any video or digital images.
I have read and understand the conditions of enrolment @ PGNS. I give permission for my child to take part at PGNS and understand all conditions set above.
Agreement Date *
Agreement Date
Selected Classes
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Please provide the following information.... class Level + class day + class time
Advanced Classes
Please enter the names of the classes below
Payment Details
Credit Card Details (VISA or MASTERCARD - NO AMEX or AMERICAN EXPRESS) - this section must be filled in. You are welcome to pay by cash, cheque or eftpos BEFORE the end of the first week of each term. Fees remaining unpaid after this will be debited from your credit card, unless a payment plan has been pre-arranged with the office.
Name on Card
Name on Card
Expiry Date
Expiry Date