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Halloween Dance PartyUrban Dance Day

Student Name*

Age*

Guardian Name (If student is under 18)

Address*

Telephone*

Email*

Medical Information
We require information about any medical conditions or allergies the dancer named above may have to inform staff and ensure the safety of our students. Please leave blank if this does not apply.
Medical Conditions or Allergies

Emergency Contact Name*

Emergency Contact Number*

Please select how you will make payment
I will transfer fees onlineI will pay by cash or cheque on arrival
(If you have chosen to transfer fees online, account details will follow)

By checking this box you agree to the dancer named above being involved in documenting the workshop by photo or video. This material may be used in future marketing.
I agree

I confirm that the information provided above is correct. I will inform RYDA as soon as possible if any of these details change.
I confirm

*Required Field