ACADEMY ENROLMENT | LIMELIGHT ACADEMY

SECTION ONE: Parent/Caregiver/Adult Information

Parent/Caregiver/Adult details

Name

Relationship to child/student

Address

Phone

Emergency contact (minimum of one name required)

Name

Relationship to child/student

Phone

Name

Relationship to child/student

Phone

SECTION TWO: Student/Participant Information

Adult/Child Name 1

Date of birth

Adult/Child Name 2

Date of birth

Adult/Child Name 3

Date of birth

SECTION THREE: SELECT YOUR LESSON

Select a lesson

10-Week Program

1-On-1

Pop Up Session

Select School Term

Term 4, 2023

Term 1, 2024

Term 2, 2024

Term 3, 2024

SECTION FOUR: MEDICAL CONDITIONS/ SPECIAL REQUIREMENTS

Any medical conditions, medications or allergies that we should be aware of?

Any behavioural, special/cultural needs that we should be aware of?

SECTION FIVE: TERMS AND CONDITIONS

I have read and understood the Limelight Academy Terms & Conditions and agree to be bound by them.View terms and conditions here

Your Name

Your Signature

Date

Thanks for enroling with us. We will be in touch with you via email and phone within the next 24 hours. We can't wait to meet you!