Southern Star Academy of Dance Enrolment Form:

*Parent Name

*Student Name

*Email

*Phone

*Student Date of Birth

Day

Month

Year

Address

*Age Student Turns in 2025

I have read and accept the Terms and Conditions

*Date Enrolled

Southern Star Academy of Dance

M: 0434 778 195

OPENING HOURS

Dance Shop at Dalby Studio

Tuesday - 3:00-6:00

15 Irvingdale Road Dalby

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