KBBA ENROLMENT FORM

Student Details

First name

Last name

Birthday

Month

Day

Year

Address

BALLET GRADE

BRANCH

Parent/ Guardian Details

PARENT/ GUARDIAN 1

Phone

PARENT/ GUARDIAN 2

Phone

WHERE DID YOU HEAR ABOUT US?

Student Medical Conditions

Please list any medical conditions that we should be aware of. Where relevant, written permission to administer epipens and an anaphylaxis plan must be submitted to KBBA prior to the student commencing classes.

Permission & Disclaimer

We occasionally use images and videos of our students. Please tick below checkboxes for permission to use your child's images in the following material:

Yes you can use images of my child in the KBBA Newsletter

Yes you can use images of my child on KBBA Facebook & Instagram

Yes you can use images of my child on the KBBA Website

The KBBA teachers are trained in correct dance technique and physical instruction; however, all dance classes can involve the risk of personal injury. Whilst KBBA prioritizes the importance of safe dance practices and takes all reasonable care in the conduct of its classes, it accepts no responsibility and excludes all liability permitted under law for injury sustained during class participation.

I hereby release and indemnify Kim Baker, her staff, agents & teachers, against any action or claim arising from participation at the Kim Baker Ballet Academy

Parent/ Guardian Name:

Signature of Parent/ Guardian

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Date

Month

Day

Year

Thank you for enrolling at the Kim Baker Ballet Academy!