DK Junior Registration Form

Date of Joining *

First Class Attended *

Other Class

Junior Member Details

Full Name *

Date of Birth *

Street Address *

Address Line 2

Town / City *

County *

Postal Code *

Parent / Guardian / Emergency Contact Details

We kindly ask that you submit 2 Contact details

Parent / Guardian Name *

Relationship to Child *

Home Telephone0 / 11

Mobile Number *0 / 11

Email Address *

Do you reside at the same address as the applicant? *YesNo

Emergency Contact Address 1Only complete if different address to the applicant.

Parent / Guardian Name *

Relationship to Child *

Home Telephone0 / 11

Mobile Number *0 / 11

Email Address *

Do you reside at the same address as the applicant? *YesNo

Emergency Contact Address 2Only complete if different address to the applicant.

Any further information you need to make us aware of?

E.G - Health or Social information

Do you have any specific health or social needs that we need to be aware of? *YesNo

CommentsE.g. list any allergies, medical conditions, and prior injuries. They should also include details about medication the student may need to keep on hand. ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE

Quick questionnaire

How did you discover the Dance Kingdom? *

Other

Have you attended any other Dance Club or Dance Class? *YesNoPlease select

Did you expect a purpose built & equipped dance club? *YesNoPlease select

Are you aware that dance teachers should be qualified? *YesNoPlease select

Are you aware that there are several levels of qualification? *YesNoPlease select