Adult Ballet Enrolment Form

Studio Information

Name: Farnborough Academy of Ballet

Address: Wavell School, Lynchford Road

Farnborough, GU14 6BH

Email: hello@farnboroughacademyofballet.co.uk

Phone: 07894 401784

Website: www.farnboroughacademyofballet.co.uk

How did you hear about us?

Personal Information

First name

Last name

Date of Birth

Day

Month

Year

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Emergency Contact Information

Please provide details of two emergency contacts.

Emergency Contact 1

First Name

Last Name

Phone

Relationship

Emergency Contact 2

First Name

Last Name

Phone

Relationship

Medical Information

Are you currently taking any medication that may affect their participation in class?

Yes - please provide further information below

No

Please provide information on the medication taken:

Medical Permission

I give permission for Farnborough Academy of Ballet staff to administer first aid treatment if required and to seek emergency medical assistance including ambulance transportation, administration of medication or treatment deemed neccessary by medical professionals