Student Registration Form

The Regency Dance Centre Dancing with Style

Student Registration Form

Congratulations on starting your dancing journey! Due to the current situation, all students are required to register in advance before attending new classes. Please select the classes you wish to attend. We will then request payment separately.

If you are a current student, you can select the 'existing account' checkbox and enter either your account number (if known) or the primary contact name on the account. If you are new to The Regency Dance Centre or haven't attended classes for more than a year, please create a new account so that we can ensure our records are current.

Primary Account Details

Primary First Name(required)

Please enter your first name

Primary Last Name(required)

Please enter your surname.

Email(required)

A valid email is required for confirmation email to be sent.

How did you hear about The Regency Dance Centre

Invalid Input

Address Line 1

Invalid Input

Town/City

Invalid Input

Home Phone No.

Please enter your phone number and only use numeric characters

Mobile

Invalid Input

County

Invalid Input

Postcode

Invalid Input

Student Details

Number of Students

1 234 Invalid Input

Student 1 Full Name

Invalid Input

Student 2 Full Name

Invalid Input

Student 3 Full Name

Invalid Input

Student 4 Full Name

Invalid Input

Student 1 Date of Birth

Invalid Input

Student 2 Date of Birth

Invalid Input

Student 3 Date of Birth

Invalid Input

Student 4 Date of Birth

Invalid Input

Are there any health problems or conditions that we need to be aware of? (required)

YesNo Please let us know if there are any health conditions or problems that we need to be aware of.

Please provide us with further details about your health condition

Invalid Input

Newsletter

Sign up to our email newsletter to get offers, news and class information straight into your inbox! It is the quickest and easiest way to stay updated on all things Regency!

Our Terms and Conditions

Indicated in the space above are any health problems or conditions of which the school should be aware (such as heart, back, medical, allergy, muscular, pregnancy, diabetes, epilepsy, chemical or neurological condition, special medication, knee/kidney/shoulder problems, etc.). I understand that risk of injury is inherent in any physical activity and I, on behalf of myself and the above named students knowingly and voluntarily accept that risk. I hereby waive and release The Regency Dance Centre and its staff from any and all claims or damages of any kind arising from any participation in an exercise and/or dance program at The Regency Dance Centre. I further certify that the aforementioned student/students is in proper physical condition to participate in classes.

I agree that I will abide by the policies and procedures put in place by The Regency Dance Centre and understand that they are in place to ensure the safety and enjoyment of all students that attend.

Invalid Input

I accept the Terms and Conditions(required)

I agree You must agree to our Terms and Conditions in order to submit this form.

Captcha(required)

Refresh

Invalid Input

You can subscribe to receive either our News, Schedule and Updates or just our Event Guide.

Contact us

If you have any queries, please do not hesitate to contact us.

Phone: 01623 55 27 37
Email: enquiries@regencydancecentre.com