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Home
About
- Our Services
Competition Promotions
Merchandise
Personal Lessons
Classes & Social Dances
Events
Contact

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Home
About
- Our Services
Competition Promotions
Merchandise
Personal Lessons
Classes & Social Dances
Events
Contact

Home
About
- Our Services
Competition Promotions
Merchandise
Personal Lessons
Classes & Social Dances
Events
Contact

Admin

Booking / Classes

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Solo Adult Membership

Adult Couple Membership

Junior Membership

Booking / Classes

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Solo Adult Membership

Date of Joining *

First Class Attended *

Other Class

Adult Solo Member Details

Full Name *

Date of Birth

Street Address *

Address Line 2

Town / City *

County *

Postal Code *

Home Telephone0 / 11

Mobile Number0 / 11

Email Address

Emergency Contact Name

Relationship to member

Emergency Home Telephone0 / 11

Emergency Mobile Number0 / 11

Emergency Email Address

Does the emergency contact reside at the same address as the applicant? *YesNo

Emergency Contact Address 1Only complete if different address to the applicant.

Any further information you need to make us aware of?

E.G – Health or Social information

Do you have any specific health or social needs that we need to be aware of?YesNo

CommentsE.g. list any allergies, medical conditions, and prior injuries. They should also include details about medication the student may need to keep on hand. ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE

Quick questionnaire

How did you discover the Dance Kingdom? *

Other

Have you attended any other Dance Club or Dance Class? *

YesNoPlease select

Did you expect a purpose built & equipped dance club? *

YesNoPlease select

Are you aware that dance teachers should be qualified? *

YesNoPlease select

Are you aware that there are several levels of qualification? *

YesNoPlease select

Consent *

Yes, I agree with the privacy policy and terms and conditions.

Adult Couple Membership

Date of Joining *

First Class Attended *

Other Class

Adult Member 1 Details

Full Name *

Date of Birth *

Street Address *

Address Line 2

Town / City *

County *

Postal Code *

Home Telephone0 / 11

Mobile Number *0 / 11

Email Address *

Adult Member 2 Details

Full Name *

Date of Birth *

Does member 2 reside at the same address as member 1? *YesNo

Street Address *

Address Line 2

Town / City *

County *

Postal Code *

Home Telephone0 / 11

Mobile Number *0 / 11

Email Address *

Emergency Contact Name *

Emergency Contact Number *0 / 11

Relationship to member(s) *

Any further information you need to make us aware of?

E.G – Health or Social information

Do you have any specific health or social needs that we need to be aware of? *YesNo

CommentsE.g. list any allergies, medical conditions, and prior injuries. They should also include details about medication the student may need to keep on hand. ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE

Quick questionnaire

How did you discover the Dance Kingdom? *

Other

Have you attended any other Dance Club or Dance Class? *

YesNoPlease select

Did you expect a purpose built & equipped dance club? *

YesNoPlease select

Are you aware that dance teachers should be qualified? *

YesNoPlease select

Are you aware that there are several levels of qualification? *

YesNoPlease select

Consent *

Yes, I agree with the privacy policy and terms and conditions.

Junior Membership

Date of Joining *

First Class Attended *

Other Class

Junior Member Details

Full Name *

Date of Birth *

Street Address *

Address Line 2

Town / City *

County *

Postal Code *

Parent / Guardian / Emergency Contact Details

We kindly ask that you submit 2 Contact details

Parent / Guardian Name *

Relationship to Child *

Home Telephone0 / 11

Mobile Number *0 / 11

Email Address *

Do you reside at the same address as the applicant? *YesNo

Emergency Contact Address 1Only complete if different address to the applicant.

Parent / Guardian Name *

Relationship to Child *

Home Telephone0 / 11

Mobile Number *0 / 11

Email Address *

Do you reside at the same address as the applicant? *YesNo

Emergency Contact Address 2Only complete if different address to the applicant.

Any further information you need to make us aware of?

E.G – Health or Social information

Do you have any specific health or social needs that we need to be aware of? *YesNo

CommentsE.g. list any allergies, medical conditions, and prior injuries. They should also include details about medication the student may need to keep on hand. ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE

Quick questionnaire

How did you discover the Dance Kingdom? *

Other

Have you attended any other Dance Club or Dance Class? *

YesNoPlease select

Did you expect a purpose built & equipped dance club? *

YesNoPlease select

Are you aware that dance teachers should be qualified? *

YesNoPlease select

Are you aware that there are several levels of qualification? *

YesNoPlease select

Consent *

Yes, I agree with the privacy policy and terms and conditions.

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Get In Touch

info@phillip-gaynor.co.uk
Dance Kingdom,Station Yard/New Dock Rd, Llanelli SA15 2EF

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