STUDENTS DETAILS

Child #1 - NEW / RETURING*

New student to MAPA
Existing / Returning student

STUDENT'S FIRST NAME*

STUDENT'S LAST NAME*

PREFERRED NAME (Optional)

GENDER*

DATE OF BIRTH*

ANY ALLERGIES, MEDICAL CONDITIONS, DISABILITIES OR SPECIAL NEEDS?*

ALLERGIES, MEDICAL CONDITIONS OR SPECIAL NEEDS:*

HAVE YOU HAD ANY PREVIOUS EXPERIENCE?*

Previous dance experience

Please provide some details of previous experience and training including other schools you've trained at and how many years. This will help our teachers ensure new students have a comfortable transition and provide them with any additional support in areas they may need.

PRIVATE LESSON DETAILS

PLEASE SELECT THE TYPE OF PRIVATE TRAINING YOU ARE AFTER*

Please select the style(s) of dance you are interested in?*

Classical Ballet
Jazz
Contemporary
Tap
Hip Hop
Latin & Ballroom
Unsure
Other

Please specify

Please let us know what style of dance you are interested in.

Please select the style(s) of Singing you are interested in?*

Pop
Musical Theatre
Jazz
Contemporary
Rock
R&B
Unsure
Other

Please specify

Please let us know what style of singing you are interested in.

Please select the style(s) of Piano you are interested in?*

Classical Piano
Jazz Piano
Musical Theatre Piano
Pop Rock Piano
Unsure
Other

Please specify

Please let us know what style of piano you are interested in.

Please select what type of acting/drama you are interested in?*

Live Stage
Film & Television
Unsure
Other

Please specify

Please let us know what type of acting/drama you are interested in.

How often would you like your private lesson to occur?*

One off Single Lesson
Casual (book as you go)
Fortnightly Lesson
Weekly Lesson

How long would you like your private lesson to go for?*

How long would you like each of your private lessons to go for?*

How many lessons do you wish to purchase?

Single Lesson
3 x Lesson Discount Package

How many lessons do you wish to purchase?

Single Lesson
3 x Lesson Discount Package
5 x Lesson Discount Package
10 x Lesson Discount Package

Price per lesson

Price: $ 0.00

Price per lesson

Price: $ 0.00

Total Price

Price: $ 0.00

Total Price

Price: $ 0.00

Total Price

Price: $ 0.00

PREFERRED DAYS & TIMES

First Preference*

Please select earliest start time

:

Please select lastest finishing time

:

Second Preference*

Please select earliest start time

:

Please select lastest finishing time

:

Third Preference*

Please select earliest start time

:

Please select lastest finishing time

:

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ACCOUNT HOLDER DETAILS

RELATIONSHIP*

Self
Mother
Father

FIRST NAME*

LAST NAME*

EMAIL*

Booking confirmation and invoices will be sent to this email

MOBILE*

POSTAL ADDRESS*

Street Address Address Line 2 City State Post Code

HOW DID YOU HEAR ABOUT US?*

If you were recommended by a specific student or parent of MAPA, please specify in the "other" box.
We'd love to send them a thank you card!

Agree to Terms & Conditions

Step 6: Agree to Terms & Conditions*

I agree to MAPA's Terms & Conditions

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Phone

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