Gender *

Female

Male

Lesson Location *

Grace Lutheran College

Dance Studio

Music Studio

Student Year Level *

Prep

Yr 1

Yr 2

Yr 3

Yr 4

Yr 5

Yr 6

Yr 7

Yr 8

Yr 9

Yr 10

Yr 11

Yr 12

N/A

Is your student subject to custody arrangements? *

YES

NO

Photo Permission *

Grace Academy includes photos/video in newsletters, magazines, multi-media presentations, on our website or social media sites such as our Facebook page. As a parent or guardian of this student, I hereby consent to the use of photographs/video taken during the course and I understand that these images will be used without names.

YES

NO

Primary Contact Name *

If over 18 please fill out this section with your own details

First Name

Last Name

Secondary Contact Name *

First Name

Last Name

Alternate Emergency Contact Number *

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