Enrolment form Name of student First Name Last Name Birthdate of student MM DD YYYY Age as of January 1st Name of guardian First Name Last Name Email * Phone (###) ### #### Address Postal Address (if different to above) Contact in case of emergency First Name Last Name Emergency Contact Phone (###) ### #### Does the student have any injuries or health conditions? Does the student have any cognitive disabilities? (We care about providing the best learning environment for your child) What classes would you like to enrol in? I hereby give permission for (please enter student's name below) to attend classes at Studio Phoenix Bass Coast (hereby known as Studio Phoenix). First Name Last Name 1. Classes are billed by the term. Missed lessons must still be paid for unless alternative arrangements have been made with Directors of Studio Phoenix. 1.1. 48 hours notice must be given for missed private lessons. Missed private lessons must still be paid for unless alternative arrangements have been made with Studio Phoenix. 2. I authorize Studio Phoenix to seek medical assistance in the case of emergency and agree to cover all medical costs incurred as a result. 3. I acknowledge that Studio Phoenix will make every effort to contact me in the case of an emergency. 4. I acknowledge that Studio Phoenix does not conduct rehabilitation classes. I acknowledge classes are for general fitness and physical and mental wellness. 5. I also indemnify Studio Phoenix and staff and volunteers against any personal loss or injury which may occur as a result of attending dance / movement classes offered by Studio Phoenix. I take full responsibility for the actions of the above student at any and all times on the premises at 184 White Road, Wonthaggi, Victoria, and at any performance / rehearsal premises hired / rented by Studio Phoenix. 6. I acknowledge that Studio Phoenix and its teachers and volunteers are not responsible for the whereabouts or actions of the above student at any time. 7. I acknowledge that Studio Phoenix reserves the right to exclude students from classes if they do not adhere to Studio Phoenix’s strict uniform policy. Details of this policy can be found on the Studio Phoenix website (www.studiophoenix.dance) and the Studio Phoenix Parent Manual. 8. I give permission for any photos/videos taken of the above student to be used for Studio Phoenix’s publicity purposes. 9. I acknowledge that due to privacy and child protection laws only persons authorized by Studio Phoenix are permitted to capture images of Studio Phoenix students; the only exception to this is when express written consent has been granted by the student’s parent/guardian. 10. I acknowledge that all outstanding accounts will incur a 10% late fee. If accounts are outstanding from previous term, Studio Phoenix will take legal action and interest will be incurred on top of outstanding balance. 11. I agree to paying a Family Enrolment fee of $40 when returning enrolment form. 12. Studio Phoenix has extra costs involved with participating in the end of year performances (participation in end of year performances is encouraged but not compulsory) 1.1.$13.50 Rehearsal fee 1.2 $48 costume hire per class 1.3 Any extra rehearsals required will be invoiced in our Term 4 “ Concert Invoice” I/We the undersigned person/s understand and accept the above terms, & have read & agreed to the conditions & rules of the studio as detailed in this document and understand that all students are enrolled and billed by the term regardless of the number of classes attended in that term, and fees are non-refundable, and that Studio Phoenix cannot offer credit. Students may be excluded from classes if accounts are not paid in full prior to students attending class. Studio Phoenix reserves the right to exclude any student and/or family from attending classes. Further charges will be incurred if accounts have to be submitted to our collections agency. One trial class per new student at class price only may be taken and subsequent classes attended will attract full, pro rata term fees. Please indicate by circling whether you will be paying: Direct Deposit / Credit Card Cash Cheque Parent / Guardian Electronic Signature (Please enter date below signature) Student's Electronic Signature (if 18 years or over) (Please enter date below signature) If you have a second, where did you hear about Studio Phoenix? Referal Instagram Facebook Newspaper Poster Other Thank you! We will be in contact shortly to confirm your child’s enrolment and first class.
