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2024 Enrolment Package

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**Please ensure you fill & submit EACH section**

Enrolment Form 2024
Student Information

I

the parent/guardian of

acknowledge that by signing this form I have read and full understood "The Platinum Zone's" Fee Policy, Terms and Conditions, Medical Statement Form and Liability Release Form. Enrolment is only effective upon receipt of full payment and signing this form.

I do / do not give permission for my child/ren to receive first aid if necessary including the administration of paracetamol/ibuprofen.

Select an option

PAYMENT OF ENROLMENT FEE IS REQUIRED TO SECURE YOUR ENROLMENT

** Enrolment Fee is per family**

Thanks for submitting!

Already Paid or Enrolling Another Student?
Please complete the form below and submit

I

the parent/guardian of

acknowledge that by signing this form I have read and full understood "The Platinum Zone's" Fee Policy, Terms and Conditions, Medical Statement Form and Liability Release Form. Enrolment is only effective upon receipt of full payment and signing this form.

I do / do not give permission for my child/ren to receive first aid if necessary including the administration of paracetamol/ibuprofen.

Select an option

PAYMENT OF ENROLMENT FEE IS REQUIRED TO SECURE YOUR ENROLMENT

** Enrolment Fee is per family**

Thanks for submitting!

Medical Statement Form 

The Platinum Zone
Kennedy Street Northam, 6401
Ph: 0412 083 482

Student Record
(Confidential Information)

Please read carefully prior to signing
 

This is a statement in which you are informed of some potential risks involved in dance associated training and of the conduct required of you during lessons. Your signature on this statement is required for you to participate in the curriculum offered by The Platinum Zone located at Kennedy St Northam Western Australia.

Read and discuss this statement prior to signing it.  You must complete this Medical Statement, which includes the medical-history section, to enrol in any classes or programs at The Platinum Zone.

 

Activities related to dance training may be demanding. When performed correctly, applying correct techniques, it is very safe.  When established safety procedures are not followed, however, there are risks.

To perform the skills required safely, you must not be extremely overweight or out of condition.  The activities related to dance may be strenuous under certain conditions.  Your respiratory and circulatory systems must be in good health.  All body air spaces must be normal and healthy.  A person with heart trouble, a current cold or congestion, epilepsy, a severe medical problem or condition, or who is under the influence of alcohol or drugs should not participate in The Platinum Zone Dance Lessons.  If taking medication consult the teacher before participating in dance activities. 

If you have any additional questions regarding this Medical Statement or the Medical History Section, review them with your teacher and or Parent/Guardian before signing this form.

 

 

MEDICAL HISTORY

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To the Student:
The purpose of this medical questionnaire is to find out if you should be examined by a doctor before participating in The Platinum Zone dance and fitness programs.  A positive response to a question does not necessarily disqualify you from participating.  A positive response means that there is a pre-existing condition that may affect your safety or health whilst participating in the skills development activities and you must seek the advice of your physician.

Please answer the following questions on your past or present medical history by clicking on the ones that apply to you.  If you are not sure, tick the box. 

If any of these items apply to you, we must request that you consult with your physician prior to participating in dance activities.

Have you ever had or do you currently have...

The information i have provided about my medical history is accurate to the best of my knowledge.

Thanks for submitting!

Please read carefully prior to signing

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I,

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hereby affirm that I have been well advised and thoroughly informed of the inherent hazards and risks of dance and associated training.

Further, I understand that acrobatic dance training involves certain risks, and injuries may occur that require medical treatment, and nonetheless agree to proceed with such training.

I hereby personally assume all risk in connection with said course for any harm, injury, or damage that may befall me as a result of my participation in the course, whether foreseen or unforeseen, and I still wish to proceed with the course(s).

 

I understand and agree that neither the teaching staff employed by The Platinum Zone; nor The Platinum Zone located at Kennedy St Northam Western Australia may be held liable in any way for any occurrence in connection with the classes that may result in injury, death, or other damages to me or my family, heirs, or assigns; and in consideration of being allowed to participate on the course(s), I hereby personally assume all risks in connection with said course(s), for any harm, injury or damage

 

that may befall me while I am enrolled as a participant/student of dance, including all risks connected therewith, whether foreseen or unforeseen; and further to save and hold harmless said activity and persons from any claim by me, or my family, estate, heirs, or assigns; arising out of my enrolment and participation in the course(s).

 

I further state that I am of lawful age[1] and legally consent to sign this affirmation and release; and that I understand the terms herein are contractual and not a mere recital; and that I have signed this document of my own free act.

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It is the intention of

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by this instrument to exempt and release the teaching staff employed by The Platinum Zone and the Platinum Zone Centre located at Kennedy Street Northam, from all liability whatsoever for personal injury, property damage or wrongful death caused by negligence.

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[1] Where a student is not of lawful age, the parent or guardian must consent to and sign this form prior to

the student participating in any dance related activities.

I HAVE FULLY INFORMED MYSELF TO THE CONTENTS OF THIS AFFIRMATION AND RELEASE BY READING IT BEFORE I SIGNED IT.

Thanks for submitting!

Affirmation and Liability Release Form 

The Platinum Zone
Kennedy Street Northam, 6401
Ph: 0412 083 482

 

Terms & Conditions

I understand that my enrolment is not secured until I have paid the $45 per family enrolment fee due at the time of enrolment.  I understand that this fee is non-refundable.  I understand that a place can not be held in a class without payment of the enrolment fees and current term fees.

 

I understand that I am fully liable to cover all costs involved with enrolling at The Platinum Zone.  Including but not limited to class fees, costume fees, concert fees etc.  I understand that all term fees are payable in full by the due date, and that any accounts left outstanding at the conclusion of a term will be handed to a debt recovery service and my child/ren will be unable to attend classes until full payment has been made.  I understand that I will be liable to cover any and all costs involved in debt recovery as well as late fees accrued.  I understand that fees, costume money, concert ticket money etc is non-refundable with the only exception being the discretion of The Platinum Zone management.

 

I understand that if I wish to withdraw from The Platinum Zone that I must advise The Platinum Zone in writing at least two weeks prior to the conclusion of the current term.  Failure to give this amount of notice will lead to being liable for the following terms fees.  Notification is also required in writing for class changes.

 

I understand that by signing and agreeing to the terms & conditions I am giving The Platinum Zone full permission to use any photographs or videos taken of my child/ren for advertising purposes including but not limited to website, facebook page, brochures etc.  I understand that if I do not want images of my child/ren to be used I must supply a withdrawal of consent in writing to The Platinum Zone.

Thanks for submitting!

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Class Selection List 2024

Please select classes:
Are you interested in dong competitions?
If YES please select yor Style Requests

Please note that you are required to participate in Private Lessons.

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You may request which dance solo styles you would like to participate in.  Please note however this is not guaranteed and teachers will advise which style the student would be best suited to if we deem your choice to not be the best fit.

Thanks for submitting!

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