REGISTRATION

Complete the form below and we’ll confirm your class placement and next steps.

Registrations are open for all levels. If you’re unsure which option to choose, leave a note and we’ll guide you.

1. Student Personal Information

Student Full Name(Required)

Name Surname

Preferred Name(Required)

ID Number(Required)

Date of Birth(Required)

Gender(Required)

Phone number(Required)

Email Address(Required)

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Upload

Drop files here or

Max. file size: 32 MB, Max. files: 3.

Photo of Student AND Copy of ID

2. Parent / Guardian Information (if student is under 18)

Primary Guardian Name and Surname

Name Surname

Relationship to Student

Phone Number

Email Address

Address

Street Address Address Line 2 City ZIP / Postal Code

3. Emergency Contact Information

Must be someone OTHER than parent/guardian if possible

Emergency Contact Name and Surname(Required)

Name Surname

Must be someone OTHER than parent/guardian if possible

Relationship to Student(Required)

Phone Number(Required)

Alternative Phone Number

4. Medical Information (VERY IMPORTANT for safety)

Any injuries (past or current)(Required)

Yes

If yes Provide details

Physical limitations(Required)

Yes

If yes Provide details

Chronic conditions (asthma, diabetes, epilepsy, etc.)(Required)

Yes

If yes Provide details

Allergies

Yes

If yes Provide details

Medications

Yes

If yes Provide details

Special needs / learning considerations

Yes

If yes Provide details

Doctor’s Name(Required)

Doctor’s Phone Number(Required)

Copy of Medical Card

Max. file size: 32 MB.

5. Dance Information

Dance styles interested in:(Required)

Competitive

Line Dance

Tiny Tots

Couples

Other (Private Lessons)

Studio Branch(Required)

Years of dance experience(Required)

Previous studio (if applicable)

Fees

Choose your plan:(Required)

Comp - 4 Hours p/m - R450

Comp - 8 Hours p/m - R700

Line Dance - 3 Hours p/m - R350

Tiny Tots - 3 Hours p/m - R300

Couples - 4 Hours p/m - R350 p/p

Private - 4 Hours p/m - R600

Payment method:

Cash

EFT

In case of EFT, please find the banking details below:

J van der Westhuizen
51015495068
Savings
Tyme Bank

Photo / Video Consent(Required)

Yes, photos/videos may be used for marketing

Yes, but only internally

Communication Consent(Required)

SMS

8. Pick-Up Authorization (for minors)

People allowed to collect student:

Name & Surname

Relationship

Phone Number

9. Rules and Regulations - Student Agreement

The purpose of this agreement is to establish clear expectations, responsibilities, and policies regarding dance instruction.

9.1. Lesson Provision

The Teacher agrees to provide dance instruction in the chosen style.

Lessons will be held at 4 Danie Theron Street, Secunda or another agreed-upon venue.
Lesson schedules will be as followed:

Monday 17:00 - 18:00 - Tiny Tots

Monday 18:00 - 20:00 – Competitive

Tuesday 18:00 - 19:00 - Line Dance

Couples & Private Lessons to be by appointment.

The Teacher reserves the right to adjust lesson times when necessary, with reasonable notice.

9.2. Fees and Payment Terms

The Student agrees to pay monthly lesson fees monthly.

Payment terms are as follows:

Payment must be made in advance before the 7th of every month.

Accepted payment methods include cash & EFT.

Late payments may result in suspension of lessons until payment is received.

Fees are non-refundable except in exceptional circumstances at the Teacher’s discretion.

There is a once off registration fee of R300-00, payable before commencement of lessons.

Additional costs such as costumes, competition fees, workshops, exams, or performances are not included unless explicitly stated.

9.3. Attendance and Punctuality

The Student agrees to attend lessons regularly and arrive on time.

Late arrival may result in reduced lesson time.

If the Student needs to cancel or reschedule a lesson, at least [24 hours] notice must be given.

Lessons missed without proper notice may be charged in full and may not be rescheduled.

The Teacher reserves the right to cancel or reschedule lessons due to illness, emergency, or unforeseen circumstances.
In such cases, an alternative arrangement will be offered where possible.

9.4. Student Conduct and Responsibilities

The Student agrees to:

Behave respectfully toward the Teacher and other students.

Follow all studio rules and safety instructions.

Wear appropriate dance attire and footwear.

Maintain personal hygiene suitable for a shared dance environment.

Participate to the best of their ability.

Disruptive, unsafe, or disrespectful behavior may result in suspension or termination of lessons without refund.

9.5. Health and Safety

The Student confirms they are physically able to participate in dance activities.
The Student agrees to inform the Teacher of any injuries, medical conditions, or physical limitations that may affect participation.
The Student participates at their own risk and agrees to follow proper warm-up, technique, and safety guidance provided by the Teacher.

9.6. Liability Waiver

The Teacher and Studio will take reasonable care to provide a safe environment.

However, dance is a physical activity and carries inherent risk.

The Student agrees that the Teacher and Studio are not liable for injuries, accidents, loss, or damage to personal property, except where caused by proven negligence.

9.7. Media and Photography Consent

The Student grants permission for photos or videos taken during lessons, rehearsals, or performances to be used for studio purposes including promotion, social media, or educational use, unless written notice is provided to opt out.

9.8. Termination of Agreement

Either party may terminate this agreement with 30 days written notice.
The Teacher reserves the right to terminate the agreement immediately in cases of:

Non-payment of fees

Repeated absences without notice

Unsafe or inappropriate behavior

Violation of studio policies

Outstanding fees remain payable upon termination.

10. Agreement Acknowledgment

By signing below, the student and parent/legal guardian acknowledge that they have read, understood, and agree to the terms outlined in this agreement.

By signing this form electronically, you acknowledge that you have carefully read and understood the above Terms and Conditions, and you agree to be bound by them. You further acknowledge that your electronic signature constitutes your lawful acceptance of this agreement and creates a valid and legally binding contract.

Student Name and Surname(Required)

Signature(Required)

Date(Required)

Guardian Name and Surname ( if applicable)

Signature

Date