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Please indicate if student is:

New student
Returning student

Student Name

Date of birth

Street address

Email *

Mobile phone number *

Name of primary contact

Primary contact relationship to student

Primary contact mobile phone number

Name of secondary contact

Secondary contact relationship to student

Secondary contact mobile phone number

Contact name and number other than parent:

Does the student suffer from any of the below?

If yes, please provide details

Please select the age group for the student enroling (age as at 1 Feb 2022)

Please select the style of dance the student is interested in learning:

Note: Not all dance styles are available to each age group. Please refer to our timetable for further information or contact mmsod@icloud.com for further details.

I agree that photographs and videos taken by MMSOD teachers may be used for promotional or marketing materials. I consent for photos of my child to be used. *

Agree
Disagree

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