Child’s First Name* :

Child’s Surname* :

Date of Birth :

Age :

Parent/Carer’s Name :

Address * :

Mobile * :

Email * :

Does your child have any medical conditions that we need to be aware of?

Free Trial Class? (only valid if you have not attended this class previously)
 Yes No

Date of Free Trial Class :

Class (refer to Class Descriptions)

Please Enrol my child into the following Class(es)

*Please read the Terms & Conditions before submitting form / Please TICK preferred class

 DANCE - Gumbell Mums + Bubs (16mths/30mths)  MUSIC - Gumbell Music Bubs (6mths/12mths)
 DANCE - Gumbell Dancers (2.5yrs - 5yrs)  MUSIC - Gumbell Music Minis (12mths – 2.5yrs)
 MUSIC - Gumbell Music Combo (6-13mths)

Please specify the day in which you would like to attend (i.e. Tuesday, Wednesday, Thursday or Friday)

How did you find out about Gumbellinas?*

Terms and Conditions

I, agree to pay all fees issued by Gumbellinas at the beginning of each term. I understand that all fees are to be paid in full and should any classes be missed during the term I will notify and arrange a make-up class with Gumbellinas. I understand that make up classes are only valid during the term in which I missed the classes.

I Agree to the Terms & Conditions 2016 as set out by Gumbellinas.

I Agree to have my child’s photo taken on occasion during class and used for Gumbellinas promotional purposes such as Facebook, Website etc. Please note names will not be mentioned in photo posts.

I understand that once I pay my Enrolment Fee 2016 of $30 I will receive a singlet/t-shirt for my child to wear in class.

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