ENROLMENT FORM

Students Name #1 *
Students Name #1
Students Name #2
Students Name #2
2. Last Name
2. Last Name
2. Students D.O.B #2
2. Students D.O.B #2
3. Parents Name
3. Parents Name
Emergency contact *
Emergency contact
Emergency contact number *
Emergency contact number
Address *
Address
Classes I would like to enrol into for 5yrs -7yrs
Classes I would like to enrol into for 8yrs -11yrs
Classes I would like to enrol into for 12yrs -16yrs
Elite courses I would like to enrol into
Im interested in finding out about masterclasses & workshops
Phone *
Phone
Does the student suffer from a medical condition or allergies which may require treatment during classes? ( Emergency Management Plan from your doctor. It is recommended a parent / guardian remains at the studio is any allergy or condition may potentially become life threatening.) *
I wish to receive emails from BASE181 Studios *
I give permission for an ambulance to be called should teachers / supervisors deem it necessary. I understand any cost associated with calling an ambulance are the responsibility of the parent / guardian. *
I have received, read, understood and agree to the Base181 Studios Student Enrollment Form and Terms and Conditions and I wish to proceed with enrolling the student. *