Exam registration form

Child's name:*

Exam Reference (as stated in email)*

Will your child be taking their exam?*

Yes
No

Email address:*

Mobile number:*

How you would like your child’s name to appear on the certificate?*

Child's date of birth:*

Child’s Ethnic Group:

Exams your child will be taking (only if your child's name is on the rehearsal list for this subject - you have been e-mailed this document):*

Ballet
Tap
Modern

It is crucial that your child attends the exam rehearsal as well as all of their dance lessons, if you have an important commitment that is unavoidable then please state the class your child will miss:

Permission for photos on Just Dance Website?*

Yes
No

Permission for photos on Just Dance Facebook?*

Yes
No

Permission for photos on Just Dance Instagram?*

Yes
No

Permission for photos on Just Dance Pinterest?*

Yes
No

Permission for photos on Just Dance YouTube?*

Yes
No

If your child is of an older age, do you give permission for your child to leave the premises unsupervised?*

Yes
No

I understand the payment is non-refundable and costs £55 per exam*

Please select to confirm

Payment will need to be made within 14 days of completing this form or your child will not be entered for their exam.

Sort Code = 09 01 28
Account Number = 49806181
Reference = students name + EXAM (VERY IMPORTANT)

Deadline for the final forms and payment is 20th December 2016.