Register Please enable JavaScript in your browser to complete this form.Dancer's Name *FirstLastDate of birth – day *12345678910111213141516171819202122232425262728293031 Date of birth – month * JanFebMarAprMayJunJulAugSepOctNovDecDate of birth – year *Address *Email *Home phoneMobile phoneAge category *4/under6/under8/under10/under13/under14/overAdultBoysClasses Enrolling in(Class / Day / Time)First Aid Information Does the dancer have any medical conditions or allergies ? Please describe in detailEmergency Contact 1 *FirstLastPhone number *Relationship to dancer *Emergency Contact 2FirstLastPhoneRelationship to dancerDisclaimer *I agreeI hereby agree to all the terms and conditions as set by MAD Dance, I understand that no liability will be taken for the loss or damage of any property, or any physical injury caused whilst at MAD Dance premises. I also adhere to paying ALL fees on time and understand these are non-refundable. I understand that if fees go into arrears that an administration fee of $50 will occur and that tuition may be refused. I agree to give MAD Dance permission and all rights to use any photography or media recordings of students for promotional purposes. Lastly, reminder notices will be sent to families by email or text regarding important notices CommentSubmit