Email *

Name *

Age *

Phone Number *

Dance Experience *
BeginnerIntermediateAdvanced

Previous Dance Style (if applicable)

Class Selection *
BharatanatyamBollywood

Area *
Rugby - HoultonRugby - CawstonRugbyCoventryLeamington SpaWarwick

Medical Information (if any)

Emergency Contact Details (Phone & Email ID) *

Disclaimer & User Agreement *

1) I give permission for my child to take part in the activities provided by Raga & Rhythm
Dance Academy Limited and for the information to be held and used.
YesNo

2) I grant permission to Raga & Rhythm Dance Academy Limited to use photos and videos filmed
during the activity for promotional purposes, including, but not limited to, their social media
platforms, website, and other marketing materials of my child.
YesNo

I grant permission to be photographed and filmed during the dance classes conducted, with the
resulting images and videos potentially used for promotional purposes, including, but not limited
to, our dance class website, social media platforms, marketing materials, and any other
promotional content deemed appropriate.
YesNo

Payment Details- Bank Transfer
Name : RAGA & RHYTHM DANCE ACADEMY LIMITED
Account Number : 24365653
Sort Code : 04-29-09
(Payment with Reference as name & location. Attach the screenshot for payment made, if unable to,
please whats app on the numbers provided on flyer))

Upload Payment Screenshot

I have read and accept the Terms and Conditions