Guidelines:

• This form need to be filled only  by those who join our class. For all general inquiries, please contact at info@sampadadance.com.sg

• Once this form is filled, you would receive an email containing the registration details. Please print the copy of this email, sign it and submit it along with registration charges in your first class.

How did you hear about us? *		Select Email Flyer Friend's Recommendation Trial Class Web Search Others If other, mention here:
Studio Location
Particular of Students
Name *
Gender *		Male Female
Date of Birth *
Address *
Email *
Phone *
Name of School and Class
Particular of Parents (To be filled for children's class)
Parent's Name
Phone (Home)
Phone (Mobile)
Email
I have read and agree with the Registration and Course Fee Policy *		Yes
Enter the code shown above *