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Individual Registration

Please enter information in the form below to complete purchase for School Holiday Program January 2024.

Discount Code (if you have one)Discounts are applied on the Next Page
Participant's First Name*
Participant's Last Name*
Post Code*
Mobile Phone*
Email*
Parent/Guardian Full Name*
Child's Date of Birth* calendar
Child's Age:*
Childs Age Group*
4-5 yrs 6-7 yrs 8-10 yrs 11-16 yrs  
Gender Identity Pronoun*
How Many Days are you Attending*
Which days are you attending?*
  Tue 16th January   Wed 17th January   Thu 18th January   Tue 23rd January   Wed 24th January   Thu 25th January  
How did you hear about KTY Dance Classes @ The Space?*
Other
Please inform us of any medical, learning or behavioural challenges.*
Please let us know if someone other than a parent will be collecting your child at the end of the day.
Thursday Afternoon Disco
Disco Thursday January 25th 2024 ($10) - 4.15pm to 5:30 pm (4 - 10 year olds)*
Yes No  
Dietary Requirements ONLY if attending the DISCO - We usually give each child a fruit drink and small packet of popcorn, please let us know if your child is not able to be given either of these (please provide a small snack from home if so).
Payment Information
Payment Method Secure Credit Card Processor
Billing Address*
Credit Card Number*
Expiration Date* /
Card (CVV) Code*
Card Type*
Card Holder Name*
iDeal Bank*
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