ENROLMENT FORM

2024 Enrolment Form

Late enrolments cannot be guaranteed a place – all past, present and future students are required to complete an Enrolment Form and Medical Consent Form.

A $30.00 deposit per person is required with the enrolment form, satisfying membership fee requirements.
The deposit will be deducted from first term fees and will only be refunded if a student does not attend any classes in 2024.

- Step 1 of 8

Student Name *

Gender *

Are you of the following origins? *

Age *

Date of Birth *

Student Phone *

Student Email *

Parent/Guardian Contact

Parent/Guardian Name *

First

Last

Address

Address Line 1

City

State / Province / Region

Postal Code

Parent/Guardian Phone *

2024 Dance Classes

All applicants must meet the minimum age requirements before 31/12/21.

Please select your Genre.

Classical Ballet - Royal Academy of Dance Syllabus (RAD)

Classical Classes (from 6 years of age)
Pre Pixies Dance (from 3-4 years of age)
Pixies Dance (from 5 years of age)
Ready Set dance (from 1-3 years of age)

Tap - The Tapatak syllabus is taught as structure for class however exams are optional.

Graded Tap (9 years plus)
Jazz/Tap (combined 1 hour class with minimum age of 6 years)

Jazz -The CSTD syllabus is taught as structure for class however exams are optional.

Graded Jazz (9 years plus)

Hip Hop

Hip Hop (minimum age of 7 years)

Contemporary Dance

Contemporary (minimum age of 10 years)
Choreography
Conditioning

Person responsible for child and payment of account

Name *

First

Last

Address

Address Line 1

City

State / Province / Region

Postal Code

Parent/Guardian Email *

Please select the items you can help with

Class Representative
Previous dance experience / dance classes at the Guild: (Classes, examinations and syllabus)
First Costume/Sewing
Do you have any specialist / work skills that you can offer

Parent or person acknowledgement * *

That I wish to become a member of the Guild and support the purposes of the guild
To be responsible for the payment of fees within the terms outlined in the Information Booklet and failure to do so may result in my child not attending class until fees are paid.
To comply with the Rules of the Guild
That my child may be requested to participate in an Eisteddfod group piece in June 2024 & a $20 levy will be charged.
That I have read and understand the Code of Conduct and the Procedure for Managing Disputes as detailed in the Guild’s Information Policy Handbook.
That my child may be requested to participate in a Showcase Gala group piece in June 2024.
That a late fee of 10% will be applied with any overdue balances at the end of each term.
And agree to the participation of my child in the end of year concert (end of November 2024 & beginning of December 2024); & understand & a $20 concert levy will be charged.

Signature

Date

Child Safe Code of Conduct. Policy – OP10-2017 *

I have read and agree to the Child Safe Code of Conduct Policy.

1. PURPOSE

This Code of Conduct, which is particularly associated with Standard 3 of the Child Safe Standards, outlines expected standards for appropriate behaviour with and in the company of children including online conduct. The Code of Conduct is to ensure appropriate behaviour with children at the Guild and to protect children from abuse. This Code of Conduct does not replace any legislative or regulatory obligations or other professional or occupational codes of conduct.

2. APPROPRIATE BEHAVIOUR

All staff, family members, volunteers, visiting professional artists or contractors are required to observe “child safe” principles and expectations for appropriate behaviour towards and in the company of children, as noted below. All personnel are responsible for supporting the safety, participation and wellbeing of children by:

● Adhering to the Guild Child Safe Policy at all time and upholding the Guild statement of commitment to child safety at all times.

● Taking all reasonable steps to protect children from abuse.

● Treating everyone with respect.

● Listening and responding to the views and concerns of children, particularly if they are reporting that they or another child has been abused and/or are worried about their safety or the safety of another.

● Guarding the cultural safety, participation and advancement of children who identify as Aboriginal or Torres Strait Islander.

● Guarding the cultural safety, participation and advancement of children with culturally and/or linguistically diverse backgrounds (for example, by having a zero tolerance of discrimination).

● Guarding the safety, participation and advancement of children with a disability (for example, during personal care activities.

● Ensuring as far as practicable that non-teaching adults are not left alone with a child.

● Reporting any allegations of child abuse to the Guild President and Child Safety Officer.

● If an allegation of child abuse is made, ensuring as quickly as possible that the child(ren) are safe.

● Supporting children to actively participate in all relevant activities where possible, especially concerning issues that are important to them.

3. INAPPROPRAITE BEHAVIOUR

All staff, family members, volunteers, visiting professional artists or contractors must not:

● Develop any special relationships with children that could been seen as favouritism (for example, the offering of gifts or special treatment for specific children).

● Exhibit behaviours with children which may be construed as unnecessarily physical (for example inappropriate sitting on laps).

● Put children at risk of abuse.

● Do things of a personal nature that a child can do for themselves, such as toileting or changing clothes.

● Engage in open discussions of a mature or adult nature in the presence of children (for example, personal social activities).

● Use inappropriate language in the presence of children.

● Express inappropriate personal views on cultures, race or sexuality in the presence of children.

● Discriminate against any child because of culture, race, ethnicity or disability.

● Have uninvited (by parent/carer) contact with a child or their family outside of our organisation. Accidental contact, such as seeing people in the street, is appropriate.

● Have any online contact with a child or their family outside of Guild sponsored digital communication modes.

● Ignore or disregard any suspected or disclosed child abuse.

Name *

First

Last

Signature *

Date *

Medical Consent Form *

I have read and agree to the Medical Consent above.

This form is intended to be used to assist The Guild in the case of any medical treatment required or medical emergency involving a student. A copy of student’s forms must be available at each studio where classes are attended. The Guild collects the information contained in this form to provide or arrange first aid and other medical treatments for students. The information collected will be held at your child’s class and will be made available to staff of the school and to medical or paramedical staff in the case of an accident or emergency. The information contained in the form is personal information and it will be stored, used and disclosed in accordance with the requirements of the Information Privacy Act 2000.

Name *

First

Last

Signature *

Date *

Emergency Contact *

First

Last

Phone

Name of Student’s Doctor *

First

Last

Phone

Has the Student Ambulance cover? *

Has the Student Private Health cover? *

Name of Private Health Fund?

Medicare Number

Please tick if your child suffers any of the following *

allergies
anaphylaxis
asthma
blood pressure
diabetes
eczema
epilepsy
fainting
fits or blackouts
hay fever
headaches
heart condition
ADHD
nose bleeds
reaction to drugs
sight/hearing problems
sun screen sensitivity
other
none

If you have ticked any of the boxes above a Medical Treatment Management Plan must be provided. Performa Plans are available from the Guild. NB. Without a Medical Treatment Management Plan the Guild can only provide first aid treatment.

Date of last tetanus injection?

Is the student presently taking any medication? *

If YES, please state the name of medication, dosage, etc...

The teacher in charge must be informed about the management of any medication. Arrangements need to be agreed on the storage and administration of medication. In all cases medication must be labelled in original packaging with the student’s name, dosage and frequency of administration. Are you aware of any physical or psychological limitations of your child? Please give details.

Consent to Medical Attention *

I have read and agree to further Medical Attention.

Is there any other information which you believe may help us to provide the best possible care? Consent to medical attention. In the case of my child requiring medical treatment or in the case of a medical emergency, I consent to the teacher in charge providing first aid or treatment as outlined in an emergency treatment plan and I further authorise the Guild, where it is impracticable to communicate with me, to arrange for him/her to receive such medical or surgical treatment as may be deemed necessary. I also undertake to pay any costs which may be incurred for the medical treatment, ambulance transport and drugs.

NOTE: All students must have a medical consent form at each studio to be able to attend classes. Return this form prior to the first class

If there are any changes to an existing medical condition, or any new medical condition a revised medical consent form and treatment plan should be submitted immediately for the safety of the student.

Please note that the Guild is not required to provide insurance cover in the case of personal accident.
Parents need to check their own policies in regard to this matter.
Student or Parent/Carer (If Student under 18 years)

Name *

First

Last

Signature *

Date *

Photography, Video, Social Media & Website Release Form. *

I have read and agree to the Photography, Video, Social Media & Website Release Form.

I hereby irrevocably authorise and grant to Mildura Ballet & Dance Guild Inc (“The Guild”) (Including other parties engaged by The Guild) the right to record me (picture and/or voice) on photographs, social media, films and /or videotape, for audio only, audio and visual and /or visual only reproduction and website use) (“The Recording”), the right to edit the Recording into a film/television programme or corporate video, and right to screen and broadcast the Recording in the film, and the right to use and to license others to use the Recording in all media, throughout the world, including for the purposes of publicity, advertising, sales and promotion of the Mildura Ballet & Dance Guild Inc. The Guild shall also be entitled to use my name and likeness, voice, biographic or other information that is public record concerning me. I hereby release The Guild from any infringement or violation of personal and /or property rights of any sort whatsoever, based upon the use of the recording and images.

I acknowledge that The Guild owns and shall own all rights, title and interest (including copyright), in the Recording. I warrant that I have full power to enter into this Release and the terms of this Release do not in any way conflict with any existing commitment on my part.

Reference to “The Recording” in this Release includes any and all edited versions made by The Guild and, further, includes any previously recorded material of mine made by The Guild.

Student or Parent/Carer (If Student under 18 years)

Name *

First

Last

Signature *

Date *

2024 Enrolment Form

Parent/Guardian Contact

2024 Dance Classes

All applicants must meet the minimum age requirements before 31/12/21.

Person responsible for child and payment of account

Click the MBG Hand Book for full version.