MKUD Jane Sandanski Enrolment Form

MKUD Jane Sandanski - Enrolment Form

Complete the form below to sign up.
Group:*

Small GroupMiddle Mixed GroupMiddle Girls GroupSenior B GroupSenior A GroupAlumni Group
Name of Dancer:*

First NameLast Name
Gender of Dancer:*
Birth Date of Dancer:*

DayMonthYear
Address of Dancer:*

Street Address

Street Address Line 2

SuburbState

PostalCountry
Mobile Contact Number of Dancer: *
Email Address of Dancer*
example@example.com
Medical Conditons of Dancer:*
Please list any medical conditions (e.g. asthma, heart condition, allergies etc.)
Emergency Contact Details
Emergency Contact Name:*

First NameLast Name
Emergency Contact Mobile Number: *
Relationship to Dancer:*
Mother/Father/Guardian/Husband/Wife
Payment Method for Fees
Please select preferred payment method for Membership Fee*

Bank TransferCashEFTPOS
Email address Membership Fee invoice to be sent to*
example@example.com
Terms and Conditions of Membership
PHOTO/VIDEO CONSENT AND RELEASE
I hereby consent and agree that MKUD Jane Sandanski may use my name or photographs/videos for marketing or advertising purposes in any and all media worldwide, including online. I waive any rights, claims or interest I may have to control the use of my identity or likeness in the photographs/videos and agree that any uses described herein may be made without compensation or additional consideration.

PRIVACY STATEMENT
The personal information requested on this form is being collected by MKUD Jane Sandanski for the purpose of enrolling you as a member of the association. The information you provide will be used solely by MKUD Jane Sandanski for the primary purpose or directly related purposes. If you choose not to provide this information, we will be unable to process your application.
Have you read and understood the terms and conditions above?*

I have read, understood, and accepted the terms and conditions for membership.
Endorsement
ENDORSEMENT
I hereby agree that I understand MKUD Jane Sandanski is governed by rules as per the Associations Incorporation Reform Regulations 2012 Part 3 and agree to abide by these rules at all times. I accept that my application and or membership can be refused or revoked at any time if I do not abide by these rules. I agree to protect the interests of MKUD Jane Sandanski and all members of this association.
Have you read and understood the endorsement above?*

I have read, understood, and accepted the endorsement above.
Signature:*

Clear
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MKUD Jane Sandanski - Enrolment Form

Emergency Contact Details

Payment Method for Fees

Terms and Conditions of Membership

Endorsement