KIDZOPEDIA EDTECH PVT. LTD.

Academy Listing Form

Academy details
1. Name of Academy: ___Lakshya Dance unlimited_______________________
2. Nature of Academy: Academic Non – Academic
3. Course / Activity: i. _Fitness Bollywood , Zumba Fitness and Masala bhnagra For ladies________________
ii. _Wedding Sangeet and Corporate Classes and Workshops __ _______________
iii. Hip Hop Classes For Kids___________________
4. Age Group: _5___ to __50___ years
5. Academy Address: _____A 13/25 DLF city Ph-1 Near Phase 1 rapid Maetro station
______________Gurugram,Haryana____________________________________ PIN: __122002_______
6. Date of inception: ___ / ___ / _____
7. Phone no. : __9818714422_____________ Mobile no. : _9810338824___________________ E-mail:
__lakshyadanceunlimited@gmail.com______________________

Personal Details
8. Name of Founder / Owner: ___Nanu Chhabra_________________________
9. Gender: Female Male Other

10. Phone no. : __9818714422_______________ Mobile no.: __________________ Email:

___lakshyadanceunlimited@mail.com_____________________

Please tick and provide the following documents:

Academy Registration Identity Proof of Owner (Aadhar Card) Passport size Photo of owner
Establishment proof

Please provide the following details for your academy listing / profiling:
Short Description of Academy
3-4 high resolution pictures of Academy
Link to Website & Academy’s Facebook page (If any)

General Terms
 Registration fee is non- refundable.
 The above information and academy details will be used only for the profiling of your academy on
Kidzopedia’s website.
 There will be no misuse of information shared by the academy on Kidzopedia’s platform.

Declaration
I agree to pay a sum of Rs. ____ to Kidzopedia for my academy registration on their website. I also hereby
confirm that the above information provided by me is correct to the best of my knowledge and any subsequent
change will be advised to Kidzopedia by me.
Specify mode of payment: __________________
Place: ________________
Date: Signature