View Classes
Registration
Register now to enrol on your selected class.
Student
First Name
Surname
Gender
Please Choose
Unspecified
Male
Female
Medicals / Recognised Disability
Personality Disorder
Deaf/deaf or Hearing Impairment
Down Syndrome
Intellectual Impairment
Learning Disability
Multiple Sclerosis
Muscular Dystrophy
OCD
Parkinsons Disease
Cerebral Palsy
Quadriplegia
Speech / Language Impairment
Spina Bifida
Tourettes Syndrome
None
Blind / Low Vision
ADHD
Autism (ASD)
Acquired Brain Injury (ABI)
Anaphylaxis
Asthma
Diabetes
Epilepsy
If not included in the list above, could you please specify any other additional needs / considerations about this student?
Please specify any allergies the student may have
List fears / triggers if any
Accessibility
No assistance required
Requires one-on-one assistance with mobility
Uses a Walker
Uses a Wheelchair
Will the student be partaking in online or in person classes?
Please Choose
In Person
Online
None
NDIS: Does this student have an NDIS Plan?
Please Choose
No, this student does not receive funding from NDIS
Yes, they are Agency Managed
Yes, they are Plan Managed
Yes, they are Self Managed
None
Creative Kids Voucher (Can be used for online classes)
Active kids voucher (can not be used for online classes)
I give Stars Within Inclusive Dance permission to use photographs and video footage for marketing and training purposes.
Yes
No
I agree to notify Stars Within of any changes that may occur.
Yes
No
I give permission for staff to seek medical attention for my child/myself in the event of an accident or emergency which cannot be treated with basic first aid, arrange ambulance transportation if necessary and agree to meet any expenses required.
Yes
No
I give consent for Stars Within to provide any relevant personal and medical information to medical staff in the event that an accident or emergency which cannot be treated with basic first aid occurs.
Yes
No
I understand that failure to provide appropriate information about the student may result in care being declined.
Yes
No
I certify that all information in this enrolment form is correct at the time of signing.
Yes
No
Customer
First Name
Surname
Email
Password
Password confirmation
I agree to the
Terms & Conditions
and
Privacy Policy
Register
