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Contact Us - Registration

Please complete the form below if you would like to register to take classes at the Elise Marie Academy of Performing Arts . Please note that it is advisable to have discussed classes with us before registering.

Surname:
First Name:
Date of Birth (dd-mm-yyyy):	- -
PhoneNo:
Address:
Medical history notes:
If under 18yrs of age or with a learning disability
Parent/Carer Title:
Surname:
Relationship to student:
Mobile:
Address (if different from above):
E-mail Address:
Username:
Password:
NB Your username and password are for access to the online forums.
Ethnic Origin:
White, UK heritage
White, European
White, other
White, type not known
Black, Caribbean heritage
Black, African heritage
Black, other
Indian
Pakistani
Bangladeshi
Chinese
Mixed Race
Other
Prefer not to say
NB This information is asked for by examination boards when entering exams.
Promotional code or how you heard of EMA (eg. msn search engine):
	I hereby give permission for the named student to take part in classes.
	I have read and understood the terms and conditions.
	I agree to the video recording of the named student during EMA public presentations and to the sale of such recordings.