2012 REGISTRATION FORM

Given Name: __________________ Surname: ___________________

Address: _________________________________________________

____________________________ Post Code: __________________

Telephone No: _________________ MobileNo: __________________

Email Address: _____________________________________________

Age: _________ years (as at 31/03/12) Date of Birth: _______________

Sex: Female Male Paper Saver: Yes No (PTO)

Parent/Guardian Name: _______________________________________

Relationship: __________________ MobileNo: __________________

Do you suffer from any injuries or medical conditions?: _______________

School/Kinda Level: __________________________________________

School/Kinda Attended: _______________________________________

Please detail previous experience: ________________________________

I wish to enrol in the following classes (please refer to timetable):

Class

Day

Time

Amount enclosed: ___________________________________________

How did you hear about Studio D?: ______________________________

I do not wish my child to be in photos to promote the school.

How many years with Studio D _____ Year started with Studio D _____

** PLEASE NOTE – For insurance reasons, a completed enrolment form and payment must be received before attending classes. All fees are non-refundable.**

Signature ______________________________ Date: ____/____/____