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    Choreography Solo Development

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    Street - Jazz - Contemporary - Ballet

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    Street Dance

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    Passion for Dance

mad4dance street dancer

Registration Form

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 £15 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. What type of dance is the student interested in?(*)
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  10. 2. Parent/Guardian contact Information
  11. First Name(*)
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  12. Surname(*)
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  13. Relationship To The Student(*)
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  14. Parent Email(*)
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  15. Contact number(*)
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  16. 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.
  17. Please tick to confirm(*)
    Please confirm
  18. 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.
  19. Please tick to confirm(*)
    Please confirm
  20. 3. Alternate Emergency contact details
  21. First name(*)
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  22. Surname(*)
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  23. Relationship(*)
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  24. Contact number(*)
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  25. 4. Terms & Conditions
  26. Please confirm you agree with the registration Terms and Conditions (opens in new window so this form will stay open in current tab)
  27. Please agree below(*)
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  28. 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.
  29. Please agree below(*)

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  30. Security - What colour is grass?(*)
    Try a capital G for Green