The Jane Moore Academy of Ballet
10 Wannan St Highett 3190 0457 13 13 20
www.janemooreballet.com.au accounts@janemooreballet.com.au
ABN 55160246459
PART/FULLTIME AUDITION APPLICATION
APPLICANT INFORMATION
Name:
Date of birth:
Height:
Gender:
M or F
City:
State:
Post Code:
E-mail:
Phone No (1):
Phone No (2):
Current address:
PREVIOUS DANCE INFORMATION
Current Dance School:
Dance Level/Grade Achieved:
Years of dance experience:
Dance Teacher/s:
Ballet Syllabus:
Previous dance history:
Phone No:
EDUCATIONAL BACKGROUND
Current Secondary school:
Year level (currently completing):
COACHING PROGRAM (PLEASE TICK)
Junior 1 and 2
TUESDAYS 9.30 – 12.00 NOON
LEVEL 1
OR
LEVEL 2
TUESDAYS 1.00 – 3.30PM and FRIDAYS 9.30 – 12.00 NOON
Intermediate Level 3
SENIOR LEVEL 4
TUES 1.00-4.00PM WED 9.30-5.15PM FRI 9.30 – 12.00 NOON
SENIOR LEVEL 5
MON 9.30-3.00PM TUES 1.00-4.00PM WED 9.30-5.15PM FRI 9.30 – 3.00PM
PAYMENT DETAILS
Payment can be sent by cheque / money order or Direct Debit BSB: 063-011 ACC: 00175993 Ref: name of applicant
Cheque /money order made payable to Jane Moore Ballet Academy
Please (X)
Audition Fee $30 (payable on the day)
AUDITION DATE
By appointment
(OFFICE USE ONLY)
Payment Received :
Receipt Given:
Chq / Money Order / Online:
Date of Audition:
Notification Given:
SIGNATURES
I declare that the information provided on this form is true and correct. I understand that this is a non-refundable application fee
regardless of audition outcome.
Signature of applicant:
Date:
Signature of parent/guardian (if applicant is under 18):
Date: