Book Your Trial – Dancing in the Stars

Class Selection(Required)

Class starting today?

Yes

If no, which date do you wish to attend?(Required)

Name of Parent/Guardian(Required)

Child Name(Required)

Date of Birth(Required)

Gender

Male

Female

Address(Required)

Street Address ZIP / Postal Code

Contact Number(Required)

Emergency Contact Number

Email Address(Required)

Do you give photo consent?

Yes

This is to help advertise Dancing in the Stars on social media (as we are a new company we are advertising on many platforms).

Medical conditions or allergies (or any additional information we may need to know about?)

Pickup required from West Jesmond?(Required)

Yes

Class Name for Pickup(Required)

Where did you hear about us?

Please take a moment to help us by letting us know where you first heard about us. Your input will greatly assist us in refining our advertising strategies.

Where?

Pickup Fee

Price:

Pickup Fee

Price:

Pick-up Fee is £3 due to class beginning at 16:00. This price includes child care until the class begins.

Total

Credit Card

Card Details

Cardholder Name