Registration Form
  • Child Date of Birth:
  • Do you give permission for your child to be treated in the event of a medical emergency?:
  • Can your child make their own way home following class? NB. DIA accept no responsibility for your childs safety once they have left the class venue:
  • Date:
  • What class(es) is your child interested in attending?:
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I/we, parent(s)/guardian(s) of the above named child accept and understand that appropriate physical contact may be necessary when giving dance related corrections and hereby give permission for Ashleigh Baecker and person(s) engaged by DIAS to do so. NB Any person(s) engaged in such a capacity will be in receipt of an enhanced  Criminal Record Bureau check.

I hereby give DIAS permission to use any still and/or moving image being video footage, photographs and/or frames and/or audio footage depicting the above named child whilst performing with DIA for any of the following uses:  Advertisements, marketing, leaflets, or any other use such as for training, educational or publicity purposes or use on Dance In Action website. NB If you do not wish your child to be photographed for the above purposes please verbally inform a DIAS representative.  

I hereby acknowledge that I have read this form and the DIAS uniform policy/term fee documentation and agree to participate accordingly.