Current Family Details

Email address (current member) *

SELECT NEAREST LOCATION *

Friends Details

Class attending *

Friend’s first name *

Friend’s last name

Friend’s parent’s first name

Friend’s parent’s email

Friend’s parent’s mobile

Any Medical Conditions We Should Be Aware Of?(If yes, please let the teacher know) *

Does this child have permission to be photographed or filmed for studio use (classes, performances, and marketing). *

Yes

No (please ensure you let the teacher know)

I confirm that the visiting child is attending with my child today, that their parent/guardian is aware of their attendance and can be contacted in an emergency if required. I understand that participation in dance activities involves physical activity and accept that NA Dance Company/Lithgow Academy of Dance, its staff and representatives will not be held liable for any injury, accident or loss that may occur during participation.