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295 Bank Street

South Melbourne, Victoria, Australia

+61 3 9696 2943

Call us for more information

SUMMER DANCE CAMP APPLICATION FORM

"*" indicates required fields

STUDENT DETAILS

NAME*
ADDRESS*
DD slash MM slash YYYY
EMAIL*
HEADSHOT TAKEN WITH YOUR MOBILE DEVICE WILL SUFFICE-Maximum 2MB file size
Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 2 MB.

PROGRAMS

SUMMER CAMP PROGRAM
Please select the Summer Camp program/s you wish to participate in:

EMERGENCY & MEDICAL INFORMATION

Do you suffer from any serious ailment or injuries?*
Have you recently been hospitalised?*
Do you suffer from any allergies?*
Are you taking any form of prescribed medication?*
Is there any other reason why you may not participate fully in the programs?*
Do you have ambulance cover?*
Do you have private insurance?*

EMERGENCY CONTACT

EMERGENCY CONTACT – ALL STUDENTS PLEASE COMPLETE
NAME*

PREVIOUS TRAINING

The summer camp programs are designed to cater for students of all levels, from beginners to advanced. To assist us in assigning you to the appropriate group, please complete the applicable sections below: No prior training is required for Under 5s - Under 13s. For seniors, prior experience is necessary.
SUBJECTS
Years of training and current standard
Years of training and current standard
Years of training and current standard
Years of training and current standard

PAYMENT METHODS

  • IN PERSON - cash or credit card payment at DW reception
  • BY PHONE - call 03 9696 2943 to pay by credit card over the phone
  • VIA TRYBOOKING.COM - once you have pressed SUBMIT, we will send you the link to pay your enrolment through this booking site

Please note: full payment must be received to secure a position in summer programs.

POLICY & DECLARATION

Parent or Legal Guardian must sign for student under the  age of 18. Please sign using the mouse/touchpad on a computer or your finger/pencil on touch devices
Signatory's Name
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.