Please enter Account Reference (shown as AC Ref at top right of recent invoice):
Account Reference *
Surname or family name
Surname
Submitted by
Email
Student Details
Student Surname / Family name (if different from above):
Student Surname
Student Address (if different from Account Address above):
Student Address
Student 1 Name
ISTD PIN (if known):
ISTD PIN
Please enter Date of Birth or Adult below:
Date of Birth
Adult?
Select one
No
Yes
Orientation
Select one
Male
Female
Other
Please state the ULN (Unique Learner Number) for the student if known:
ULN
Subject 1
Select one
Ballet
Modern Theatre
Tap
Commercial Jazz
Musical Theatre
Contemporary Dance
Class Code of preferred class(es):
Class Codes
Subject 2
Select one
Ballet
Modern Theatre
Tap
Commercial Jazz
Musical Theatre
Contemporary Dance
Class Codes
Subject 3
Select one
Ballet
Modern Theatre
Tap
Commercial Jazz
Musical Theatre
Contemporary Dance
Class Codes
Student 2 Name
ISTD PIN (if known):
ISTD PIN
Please enter Date of Birth or Adult below:
Date of Birth
Adult?
Select one
No
Yes
Orientation
Select one
Male
Female
Other
Please state the ULN (Unique Learner Number) for the student if known:
ULN
Subject 1
Select one
Ballet
Modern Theatre
Tap
Commercial Jazz
Musical Theatre
Contemporary Dance
Class Code of preferred class(es):
Class Codes
Subject 2
Select one
Ballet
Modern Theatre
Tap
Commercial Jazz
Musical Theatre
Contemporary Dance
Class Codes
Subject 3
Select one
Ballet
Modern Theatre
Tap
Commercial Jazz
Musical Theatre
Contemporary Dance
Class Codes
MEDICAL DECLARATION AND EMERGENCY ACTION
Please give details below of any medical condition (e.g. asthma) which may affect the participating in a physical activity of ny of those students listed above, together with details of any medication required, and whether he/she is able to administer this his/herself:
Student 1
Student 2
Ambulance in emergency if Parent / Guardian cannot be reached
In the event of an emergency, should a teacher or other representative of the School consider it necessary, I agree to an ambulance being called for any of the students listed above (the School's policy is ALWAYS to contact a parent via the provided numbers in the first instance where time allows)
Ambulance *
Select one
Accept
Decline
Signed *
Relationship *
Select one
Parent
Guardian
Self
Submit