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Student
First Name
Surname
Gender
Please Choose
Unspecified
Male
Female
Medical information - Please select the statements that are applicable to your child
Not applicable
Other condition or concern we should know about
Heart condition or blood pressure issues
Chest pain or dizziness when exercising
Seizures or fainting spells
Bone, joint, or muscle issues
Asthma, diabetes, or another chronic condition
Had surgery or been hospitalised in the past 12 months
Allergies (e.g., to food, medicine, or insect bites)
Currently takes medication (that we should be aware of)
SEN Support
Anaphylaxis
Epilepsy
If you selected any of the above please give further details below.
I consent for Jasmine Dance Academy teachers to administer first aid on my child if required
Yes
No
Photo consent (including Social Media usage)
Yes
No
School Year
Customer
First Name
Surname
Email
Password
Password confirmation
Is the emergency contact for the student the same customer details given above?
Yes
No
I (Parent/Guardian) certify that all information provided is accurate to the best of my knowledge.
I (Parent/Guardian) understand dance is a physical activity, and all participants take part at their own risk.
I will inform Jasmine Dance Academy of any changes to my child's medical status.
I agree to the
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and
Privacy Policy
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