EPA Online Registration

Registration

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Welcome to EPA! Please complete the following registration form.

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

County*

Postcode*

Home or Primary Phone*

Additional Info

Emergency Contact Info<br/>(Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Home Phone *

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

How can we contact you?

Home Phone *

Work #

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=dd/mm/yyyy)

Cell #

Additional Info

Student Email*

Day time School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Photo/video release? (Yes/No)*

Please click on the Search button below, then choose the class you wish to register for.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=dd/mm/yyyy)

Cell #

Additional Info

Student Email*

Day time School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Photo/video release? (Yes/No)*

Please click on the Search button below, then choose the class you wish to register for.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=dd/mm/yyyy)

Cell #

Additional Info

Student Email*

Day time School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Photo/video release? (Yes/No)*

Please click on the Search button below, then choose the class you wish to register for.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=dd/mm/yyyy)

Cell #

Additional Info

Student Email*

Day time School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Photo/video release? (Yes/No)*

Please click on the Search button below, then choose the class you wish to register for.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=dd/mm/yyyy)

Cell #

Additional Info

Student Email*

Day time School*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Photo/video release? (Yes/No)*

Please click on the Search button below, then choose the class you wish to register for.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

(Show-Hide Details)

Release of Liability/Assumption of Risk

LIABILITY RELEASE FORM AND ASSUMPTION OF RISK

I/we realise that participation in dance classes and activities could result in personal injury. Despite precautions being taken by the studio, accidents and injuries may occur. By signing this release form I/we (the dancer and parent/guardian) assume all risks related to the use of any and all spaces used by Expressions Academy of Performing Arts Ltd.,

I/we agree to release from responsibility Expressions Academy of Performing Arts Ltd., including all teachers, dancers, staff members and facilities used by both entities from any cause of action, claims or demands now and in the future. I/we will not hold Expressions Academy of Performing Arts Ltd liable for any personal injury including: scrapes, bruises, cuts, sprains, fractures, broken bones, concussions or death or any personal property damage/loss which may occur on the premises before, during or after classes.

Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our behaviour in addition to any damage I/we may cause to the facilities at Expressions Academy of Performing Arts Ltd.,
I understand that Expressions Academy of Performing Arts Ltd are licenced, accredited and insured organisations. In the event that I/we should observe any unsafe conduct or conditions before, during or after my classes, I/we agree to report the unsafe conduct or conditions to Maxine Glasby, owner, the administration, instructors or staff members as soon as possible.

PHOTOGRAPHY/VIDEO - I give permission for my son/daughter's photographs/videos to be used for publicity and advertising the studio, on the Expressions Performing Arts website, Facebook group or in the community

I agree to my child participating in dance including stretching, kicks, cardio exercise and at times tricks/gymnastic movements - always with a mat involved.

I am happy for my child to be photographed as stated above

Principal: Maxine Glasby
3 Newgate Lane, Mansfield, Nottinghamshire. NG18 2LB
Telephone: 01623 424334 Email: office@epa-academy.co.uk

www.epa-academy.co.uk

A non-profit company limited by guarantee for the benefit of current & future students of the Academy
Expressions Academy of Performing Arts.
Company Registration Number 7328980

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

County

Postcode*

Registration

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies and Agreements (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies and Agreements

(Show-Hide Details)