PHOTO 1
COPY PHOTO
Please add clear head
& shoulders photo of
student
Please add clear head
& shoulders photo of
student
2013-14
(Ideally passport size)
(Ideally passport size)
Registration
Name _________________________________________ Age
Dob ____/____/____
_______
School Yr ________
Email - Block capitals in box below
Address
___________________________________________________________________________________
______________________________________________________ Postcode _______________________
Home Tel no: ______________________________ Mob 1 name & no:_______________________
Mob 2 name & no___________________________Student mobile ______________________________
Child performance Licence info required
Copy of birth certificate / passport
Yes
Already completed July 2013
School name ___________________________________________________________________________
Headteacher name ______________________________________________________________________
Medical declaration
_______________________________________________________________________________________
_______________________________________________________________________________________
____________________________________________________________
As a parent / carer I accept that it is my responsibility to inform the teacher of any relevant medical
history and will be available on the telephone numbers above in the case of an emergency. I understand
that my child is participating in the class at their own risk.
Signed ______________________________________________________________________
STUDENT CODE OF CONDUCT
Dexterity, Estha Jones School of Dance Ltd, take very seriously the health, safety and welfare of all students,
teachers and assistants whilst accessing our classes, therefore for your own safety and that of others, please ensure
that:- (please tick each bullet point on reading to agree and sign at the end)

I will ensure I have eaten sufficient food and drunk enough water to provide the necessary energy for my
participation in lessons. I understand I will need healthy snacks to maintain energy levels.

I will develop a “thick skin” and not take constructive criticisms personally.

I will have full Dexterity uniform for class and appropriate warm clothing to travel to and from class.

I will wear uniform when representing Dexterity, Estha Jones School of Dance outside of school.

I will respect other students and teachers for their hard work and determination and speak to one
another with kindness, truth and in a respectful manner at all times.

Look out for the well-being of younger and less experienced members of Dexterity and always lead by
example. I will always remember that I am a role model and leader of my peers and will act accordingly

I recognise that good attendance is imperative as absence and lateness can hold back an entire class.
I will, therefore, make every effort to attend every class, and be on time for a thorough warm up.

I will practise my strength and flexibility at home and rehearse my dance movements.

I will take good care of and return dance costumes and any materials loaned or given to me.

I will check the floor is clear. All belongings are out of the way and will not cause anybody to trip or slip.

Any spillages are mopped up. Only water allowed in the studios – not near electrical items.

Use the changing rooms for personal possessions. We will not be responsible for the loss or damage of
any personal items.

All jewellery removed.

Footwear or bare feet must be appropriate for the style of dance (ask the teacher for the class if you are
unclear of recommendation) so that you are safe cannot cause damage to yourself, somebody else or the
floor.

Consumption of tobacco and/or intoxicants is not allowed on the premises. The class should not be
attended if under the influence of intoxicants.

Be aware of people around you to avoid hitting or bumping into them.

If any movement hurts, do not do it and inform your teacher.

Feel free to sit out if tired.

Please remove heeled shoes to avoid damaging the floor.

Look in lost property for mislaid items.
I have read and understand the above rules and agree to abide by them.
Signature: ___________________________ Print Name: ______________________________________
Parent / carer sign (under 18s only) _______________________ _____Date: ______________
PAYMENT AGREEMENT
Payment can be made direct to Estha Jones School of Dance Ltd, bank account prior to the start of each term.
Estha Jones School of Dance Ltd Account number: 03603008 Sort Code: 20-61-51
Reference: Your child’s name. (Please use your child’s 1st initial and surname as a reference).
Please also ensure you notify us by email as soon as the payment is processed to dexteritydance@gmail.com .
Paying by cheque or cash will incur an additional £1 banking fee. We will need this also in advance, please send cheque to
Dexterity - Estha Jones School of Dance Ltd
1 Vicarage Lane, Denton, Northants. NN7 1DT
Payment:
Please note all monies and cheques should be paid to Estha Jones School of Dance Ltd
c/o 1 Vicarage Lane, Denton, Northants. NN7 1DT
Monthly payments now compulsory for all. If payment point not met students will not be permitted to participate.
Payment point 1 22nd April
Payment point 2 22nd May
Payment point 3 22nd June
I, __________________________________ (name) understand, by signing the Declaration of Payment, that I agree
to the terms and conditions detailed therein.
SIGNED ______________________________________
DATE: __________________________
Please note finance and admin staff available to help and receive payment on Saturday mornings from
9am-2pm
Contact Details:
Website
www.dexteritydance.com
Email
dexteritydance@gmail.com
Telephone Mobile (Estha)
07971 822009
Madelaine Norridge, a parent who is a qualified Physiotherapist, has agreed to
continue to support the development of our students at Dexterity.
Madelaine will be working alongside the dance tutors at Dexterity in her professional capacity as a Physiotherapist to provide
advice and guidance about individual physical development. She will be looking to reinforce the excellent advice and guidance
that students are already given and provide advice about the avoidance of injury or repetitive strains. This will include
observation of dance sessions, individual assessment of students and at times advice about personal exercises or stretches
where appropriate. At times this may include treatment of specific injuries and for this you are required to give consent. As a
qualified physiotherapist and first aider, Madelaine is looking forward to continuing to work with the Dexterity team.
Please indicate whether you are happy for Madelaine to assess your son or daughter by returning the attached slip below.
Please be aware your son or daughter will not be able to take part in this service until you have provided consent. If you have
any further questions regarding this service, please direct them via email at dexteritydance@gmail.com and they will be passed
on to Madelaine. Alternatively you can talk to Madelaine directly at Dexterity on Saturdays between 9.30am and 1.30pm.
You will need to complete a separate slip for each child attending where you have more than one.
I ……………………………………………………………. give consent for …………….………………………………………. to be
Individually assessed, advised and where necessary treated by Madelaine Norridge.
Please provide details of any other treatment for any injuries below:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Parental signature: ……………………………………………………………….(Print Name: …………………………………………………….. )
Date: …………………………………………
IMAGE RELEASE DECLARATION
I understand that performances and rehearsal times may be photographed and filmed and that images will be captured and
used for publicity and promotional purposes by Dexterity, Estha Jones School of Dance.
These images will not be accessed by any third party for any use other than for those already stated.
Parents Signature: _______________________________ Name: _________________________________