StudioScene Brunei Sdn Bhd

online enrolment

SELECT DANCE STYLES

Dance Style 1: Beginner: Grade:

Dance Style 2: Beginner: Grade:

Dance Style 3: Beginner: Grade:

Dance Style 4: Beginner: Grade:

STUDENT PROFILE

Name:*

Date of Birth:* (dd/mm/yyyy)

Gender:* Male: Female:

Address:*

Mobile Phone Number: Work Phone Number:

Home Phone Number: E-mail Address:*

Previous Dance Experience? Yes: No:

PARENTS/GUARDIAN PROFILE

Name:

Relationship to Student: Father: Mother: Guardian:

Address:

Mobile Phone Number: Work Phone Number:

Home Phone Number: E-mail Address:

MEDICAL INFORMATION OF STUDENT

Please describe any relevant health problem:

Known Allergies:

Regular Medication:

EMERGENCY CONTACT

Name:

Telephone Number: