ENQUIRY FORM

PLEASE COMPLETE THE FORM BELOW FOR THE DANCE PROGRAM YOU ARE ENQUIRING ABOUT

Dance Programs

Panda Squad

Next Gen 3019 (Sunshine)

Next Gen 3029 (Wyndham)

Breaking @ Braybrook

First Name

Last Name

Gender

Male

Female

Other

Date of Birth

Suburb

What Country Were You Born in?

Age

Phone Number

What Language Do You Speak At Home?

Previous Dance Experience

None

Beginner

Intermediate

Advanced

Name Of Emergency Contact

Emergency Contact Number

Language Preferred By Contact Person

Interpreter Required

Yes

Please Tell Us If Your Child Has Any Medical Concerns, Disabilities, Allergies Or Is Taking Any Medication?

In A Few Words Please Tell Us Why You Want To Join L2R?

In A Few Words Please Tell Us How You, Your Child And Or Family Align with L2R's Charitable Mission?

Please note that by completing this form your child is not guaranteed a place in the requested program. One of the L2R team will be in touch shortly!

Thanks for registering your interest. One of the L2R team will be in contact with you shortly for a chat!

ABN 60 571 086 140