Fusionone Adult's Enrolment Form

Stacks Image 128

begin it ...

… live it ...

dance it

Home
About Us
- The Team
- Locations
Dance Classes
Enrolment
Timetable
Term Dates
News
Events
Gallery
Student Resources
Online Ordering
Contact Us

Adult Enrolment Form

Stacks Image 316

Thank you for your interest in enrolling with Fusionone.

Below you will find our online adult enrolment form however, should
you wish to download a form to fill out and send us, you can find it here.

Adult online enrolment form

Title *

First Name *

Surname *

Age *
Date Of Birth *
Occupation

Address *

Suburb *

Postcode *

Home Phone *
Work Phone
Mobile *
Email Address *
Emergency Contact Name *
Emergency Contact Number *
In the event of a medical emergency and the above emergency contact cannot be reached, do you authorise Fusionone to seek medical advice at a hospital? Yes No
What other type of activity/ sports are you actively involved in?
What would you like to achieve from the class?
Which classes are you enrolling in?

For a list of class times, see our timetable

1. Class *
example: Kindy Tap

1.Day *
example: Thursday

1.Time *

2. Class

2.Day

2.Time

3. Class

3.Day

3.Time

4. Class

4.Day

4.Time

5. Class

5.Day

5.Time

Do you have any medical conditions or injuries which Fusionone should know about?
Do you have any allergies?
What are your hobbies/ interests?

Have you participated in any dance classes before? * No Yes
If so, where and when?
How did you hear about Fusionone? * School Newsletter Newspaper Friend Carroll Directory Mail Word of mouth
What other classes would you like to see at Fusionone?
I hereby grant the right to use my photo or likeness to promote the interest of fusionone without my further consent being obtained * I agree

© 2011 Fusionone

site designed and maintained by Clever IT Systems