The Ritz Performing Arts Centre 2011 Enrolment Form

1. Student Details
2. Full Name:(*)
   Please enter your full name
3. Date of Birth:(*)
   Please enter your date of birth
4. Student Address:(*)
   Please enter your address
5. Postcode:(*)
   Please enter your postcode

6. Student Phone Numbers
7. Home:(*)
   Please enter a contact number
8. Work:
   Invalid Input
9. Mobile:
   Invalid Input

10. Student Details
11. Student email:(*)
    Please enter a valid email address
12. Medical information (eg asthma):
    Invalid Input
13. School / ed. inst. attending:
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14. Grade:
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15. Can student read music?
    Invalid Input
16. Any previous dance/drama/singing/acrobatics experience?
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17. How you found out about The Ritz
18. How did you find out about The Ritz? (please tick any that apply)
    Internet
    Studio sign
    Car signage
    Shopper Docket
    Newspaper Ad
    Newspaper Story
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19. If a person referred you to us, please name that person:
20. Ritz Student name:
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21. Ritz Teacher name:
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22. Someone else, eg podiatrist:
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23. If you saw a Ritz performance, where was it?
24. Eisteddfod:
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25. Other place:
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26. What would you like to achieve at The Ritz Performing Arts Centre?

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27. Account
28. Accounts are the responsibility of persons #1 & #2 unless you specify otherwise on this form, OR: are you an adult student and responsible for this account?
    YesNoInvalid Input

29. Parent / Guardian / Carer / Partner #1:
30. Relationship to student:
31. preferred title:
32. full name:
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33. home address:
    Invalid Input
34. postcode:
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35. home phone:
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36. mobile phone:
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37. work phone
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38. occupation:
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39. work address:
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40. email:
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41. Parent / Guardian / Carer / Partner #2:
42. Relationship to student:
43. preferred title:
44. full name:
    Invalid Input
45. home address:
    Invalid Input
46. postcode:
    Invalid Input
47. home phone:
    Invalid Input
48. mobile phone:
    Invalid Input
49. work phone
    Invalid Input
50. occupation:
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51. work address:
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52. email:
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53. Parent / Guardian / Carer / Partner #3:
54. Relationship to student:
55. preferred title:
56. full name:
    Invalid Input
57. home address:
    Invalid Input
58. postcode:
    Invalid Input
59. home phone:
    Invalid Input
60. mobile phone:
    Invalid Input
61. work phone
    Invalid Input
62. occupation:
    Invalid Input
63. work address:
    Invalid Input
64. email:
    Invalid Input

65. Declaration

    (I am / We are) responsible for prompt payment of this account including late fees. (I/We) understand that the persons named in this form are bound by the Terms and Conditions of the Ritz Performing Arts Centre. (I/We) understand that the Terms and Conditions are published in the 2011 Prospectus & Timetable/Fee Schedule.