M4D Logo 2019

  • Being a Family

    Being a Family

  • Empower and Inspire

    Empower and Inspire

  • Helping to Grow

    Helping to Grow

  • Nurturing Confidence

    Nurturing Confidence

  • Succeed and Achieve

    Succeed and Achieve

mad4dance street dancer

Registration Form

If you would like your child to attend a FREE trial lesson please complete the Book a Trial Form or, to register your child's place, please complete the form below. Upon receipt you will then be emailed payment details. Thank you.

There is a registration fee of £20 which includes a welcome pack and Mad4Dance t shirt. You will be emailed to confirm the remaining amount owed for classes for this month along with the registration fee. The total amount will then be debited from your account within 5 working days. Monthly direct debit payments will then start from 20th of each month.

  1. 1. Student Details
  2. First Name(*)
    Please let us know your name.
  3. Surname(*)
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  4. Date of Birth(*)
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  5. Age(*)
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  6. Home Address(*)
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  7. Postcode(*)
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  8. School Attending(*)
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  9. School Year(*)
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  10. Day and style of class you would like to book your child onto(*)
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  11. 2. Parent/Guardian contact Information
  12. First Name(*)
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  13. Surname(*)
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  14. Relationship To The Student(*)
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  15. Parent Email(*)
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  16. Contact number(*)
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  17. Parental Responsibility
    I confirm that I have parental responsibility for the above named child and I undertake to inform Mad4Dance of any changes to the information provided.
  18. Please tick to confirm(*)
    Please confirm
  19. Medical Information Confirmation
    I confirm that my daughter/son is in good health and I give consent for my daughter/son to participate in Mad4Dance classes, exams, workshops and performances.
  20. Please tick to confirm(*)
    Please confirm
  21. 3. Alternate Emergency contact details
  22. First name(*)
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  23. Surname(*)
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  24. Relationship(*)
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  25. Contact number(*)
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  26. 4. Terms & Conditions
  27. Please confirm you agree with the registration Terms and Conditions (opens in new window so this form will stay open in current tab)
  28. Please agree below(*)
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  29. I grant Mad4Dance full right to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, marketing or publicity. This might include, but is not limited to, the right to use them in their printed form and online publicity, website, social media and press releases.
  30. Please agree below(*)

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  31. Security - Which is larger 4 or 7?(*)
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