Brookvale Dance Centre Introductory class

Step 1: Parent Information

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First Name:

Last Name:

Email:

Phone

Secondary Carer / Emergency contact First Name

Secondary Carer Surname

Secondary Carer Phone

Step 1: Student Information

Note if you are an Adult learner please re-enter your details

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Student First Name

Student Last Name

Date of Birth

Current Age

Medical Needs

First Class Date & Time

Please list the classes you wish to attend in your first week.

Step 2: Postal Address

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Address:

Suburb:

Postcode

Step 3: Payment Information

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Name On Card:

Card Number

CVC

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