EmailMe Form - PiP Application Form

PiP Application Form

Students Name *
First Last
Date of Birth *
DD/MM/YY
Students Email *
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Students Mobile
(If applicable)
Parent/Guardian Details
Name *
First Last
Email *
Phone Number *
Emergency Contact Number
(If different from above)
Most Confident Discipline *
Acting
Singing
Dancing
Please choose one
Least Confident Discipline *
Acting
Singing
Dancing
Please choose one
In one sentence, please describe where you hope to see yourself in 3 years. *
Are you in or about to commence professional training? *
Yes
No
If yes, where and what course?
How did you hear about PiP?
Word of mouth
Facebook
Twitter
Referred by friend
Other
If other, please specify
If referred by friend, who referred you?
Please inform us if there are any medical conditions you feel we should know about.
Terms and Conditions *
I have read and agree to the terms and conditions.

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