CEC/CTP/CEP ACCEPTANCE | Independent Dance

Applicant's First Name

Applicant's Surname

D.O.B

Day

Month

Year

SELECT AN EXTENSION PROGRAM

Classical Extension Class

Classical Transition Program

Classical Extension Program Level 1

Classical Extension Program Level 2

Classical Extension Program Level 3

Classical Extension Program Level 4

RAD LEVEL (CEP ONLY)

PARENT/GUARDIAN INFORMATION:

Primary Parent/Guardian (full name)

Email Address (for all invoicing)

Best Contact Phone Number

Emergency Contact (name and phone number)

Address

House No, St Name, City, State, Postal / Zip Code, Country

ACEPTANCE Ts&Cs. Please note your application will not be complete until your deposit is received as follows:

CEC $50.00

CTP $100.00

CEP $500.00

All deposit payments are deducted from your term one program invoice and secure your place in your selected program for the full year.

PAYMENT DETAILS

ACC: Independent Dance Studios

BSB: 013 479

ACC: 151310014

REFERENCE: Your child's surname

Parent/Guardian please sign here to agree to the above

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.