Street Dance Club
Bringhurst Primary School

STUDENT DETAILS (required)

Student First Name

Student Last Name

Student Age

Student Date Of Birth (DD/MM/YY)

Students Class

ADDRESS (required)
Address line 1

Address line 2 (optional)

City/Town

Postcode

MEDICAL INFORMATION
If you or your child has any known medical requirements/conditions or learning difficulties please provide full details here. This is essential so we are able to give the best care to our students. (leave blank if not applicable)

PARENT/GUARDIAN DETAILS (required)

First Name

Last Name

Relationship to Student

Emergency Number

Email Address for Correspondence

RYDA REGISTRATION– TERMS & CONDITIONS

Please read and tick each box to show your agreement.

Health Declaration
I confirm that the dancer being registered is physically fit to participate and will inform the academy of any medical conditions or injuries.

Photography & Video Consent
I give permission for photos or videos of me (or my child) taken during classes or events to be used for academy promotional purposes (e.g., website, social media, print).

Payment Agreement
I agree to pay tuition fees by bank transfer prior to attending classes. I understand that missed classes are non-refundable unless cancelled by the academy.

Data Consent
I consent to the academy storing my (or my child’s) personal data securely for administrative and emergency purposes only.

Emergency Permission
In an emergency, I authorise academy staff to act in the best interest of my child and contact medical services if required.