Student Details Information Student Information and Emergency Contact details Student Surname*Student First Name*Date of Birth* Age*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Mobile*Emergency Contact Name*Emergency Contact Number*Emergency Contact Email* Authorised Persons for Collection*Please provide full names and phone numbers, or state not applicable. Medical Assistance* Yes No Please state if permission is given for Decorus Academy to perform First Aid if required during class.Allergies*Please advise of any allergiesMedication*Please advise off any medication takenCurrent Ballet Syllabus / Grade*NoneBBO Level 1 ( Grades 1-3)BBO Level 2 ( Grades 4 to 5 & Intermediate Foundation)BBO Level 3 ( Grades 6 to 8 & Intermediate)BBO Level 4 ( Advanced 1 & 2)ISTD Ballet Pre-Primary & PrimaryISTD Ballet - Grade 1-3ISTD Ballet - Grade 4-6RAD Ballet - Pre-Primary & PrimaryRAD Ballet - Grade 1-3RAD Ballet - Grade 4-6RAD Ballet - Grade 7-8RAD Ballet - Intermediate Foundation & IntermediateRAD Ballet - Adv Foundation & Advanced 1RAD Ballet - Adv 2 & Solo SealNumber of Years Studied*Other Dance Styles* None Modern Jazz Musical Theatre Dance Acro Tap Pointe Pas de Deux Drama Please select all other dance styles studiedExaminations* Ballet Dance Acro Tap Modern None Please select if you would like to take examinations. Please note examinations are not compulsory.Photography/ Videography Permission* Marketing Material DA Website Social Media e.g. Facebook, Instagram None Please advise if Decorus Academy can use images of your child for marketing and promotion purposes.Mailing List* Yes No Subscribe to Decorus Academy Mailing List which provides information on the following and much more; Class updates, Examinations, Annual Show, Auditions, DA Newsletter, Dance Festivals, Dance Workshops Disclaimer* Accept Terms & Conditions I confirm all information is accurate and I have read and accept Decorus Academy Terms and Conditions, https://decorusacademy.com/terms-conditions/