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Student name
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Date of birth
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Phone
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Secondary contact
Preferred rehearsal day MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Allergies the Got Ya Back staff should be made aware of YesNo
Other medical, behavioural, disability information that could assist the staff YesNo
In the event of sudden illness or accident, I give permission for Got Ya Back staff to seek medical assistance if required YesNo
I have read, understand and agree to:
Fee structure YesNo
How would you like to pay your fees? Pay Advantage/Direct DebitOne Up Front Payment
I give permission for photographs/video to be taken of my child cor promotional purposes only. YesNo
Images of my child may be used in mediums including: publications and promotional material, and broadcast, print and electronic media. Got Ya Back Productions will not to use your child’s image in a manner that may be deemed adverse or defamatory. The image will remain the property of Got Ya Back Productions Pty Ltd and any personal details regarding this image will be kept confidential and will not be used for any purpose other than related to our business.
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