After School Club Registration

Child's Name *

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Child's School Year *

School *

Phone *

Email *

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Does Your Child Have Any Medical Conditions or Special Educational Needs? If Yes Please Explain

Does Your Child Suffer From Any Allergies? E.g Food, Medication, Plasters etc

Does Your Child Require Any Prescribed Medication During Classes?

I agree for Bpm Dance Academy to use the information you provide on this form to be in touch with you and to provide updates and marketing.

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Date *