Classes Application Form

Please fill in your details and press the submit button to apply for classes

I M P O R T A N T !
Please note that by submitting this form to Lafour, you accept all of the terms, conditions and health regulations as set out on the
Lafour Terms and Conditions page

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Updated 16-Dec-2008 15:23
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Age :
Address :
Postcode :
Home Telephone No. :
Please include area code
Mobile Telephone No :
Email :
Emergency Contact Name :
Emergency Contact Tel No. :
Relationship :
Health Club Membership No. :
RAD Pin No. :
ISTD Pin No. :
Are there any medical conditions we need to be aware of? :
Doctor's Name :
Doctor's Surgery Address :
Doctor's Telephone No. :
If applicable
If applicable
If applicable
1st Steps Dance (3-4) :
Ballet (4+) :
Tap (6+) :
Modern (6+) :
Street/Jazz (8+) :
Please tick the boxes to indicate the classes of interest and supply all other details
Class
Location
Day
Time
Preferred start date
Student name :
Press the submit button to send
Yellow fields are mandatory
Lafour Theatre Club (4-6) :
Lafour Theatre Club (7-9) :
Date of Birth :