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  • Registration form - Dance for Parkinson's & Wellbeing

    You must complete this form to be able to participate in classes, if you prefer there is a paper copy of this form you may fill in. To view our Privacy policy please head to: https://drive.google.com/open?id=1qWZAMV3zYmWNl1JVXNs3uEUhQm972fIC
  • Personal information

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  • Health questions

  • Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO and add information if the answer is Yes

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  • If there are any changes to an existing medical condition, please inform your teacher as soon as you can.

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  • Please note:

    Dance classes can involve risk of personal injury. While teachers take all reasonable care in the conduct of classes; they accept no responsibility for injury or loss caused during classes or whilst participants are at or near the dance space. You are responsible for ensuring that you are physically and mentally fit for the class, and during the class you must at all times take care of your own personal safety.
  • Payment & Declaration

  • Classes can cost between $0 and $25 each, depending if the program has received funding, or if you are a concession card holder.

    Dance for Parkinson's & Wellbeing complies with the NDIS Code of Conduct and we offer the option of invoicing a dancer after each term of classes, otherwise classes are to be paid each week of attendance.

    Cash is currently accepted each week, however, if enough people would like it we will evaluate an EFTPOS/Credit card option.

  • I am aware of the risks in observing or participating in the dance classes offered by Dance for Parkinson's & Wellbeing and I understand that all dance that I will participate in is entirely at my own risk.  I understand that I must look after myself and my own health and safety and assume complete responsibility and liability for those risks and for the injuries that may occur as a result of these risks, even if injuries occur in a manner that is not foreseeable at the time I sign this agreement. I realize that by voluntarily assuming the risks involved, I will be solely responsible for any loss or damage I sustain, including personal injuries to me, damage to my property, or damage arising out of my death. It is understood that Dance for Parkinson's & Wellbeing is responsible for any damage that would be resulting from a fault of Dance for Parkinson's & Wellbeing and its representatives. 

  • If you understand all you have read and declare it to be true and accurate, please sign and date below.

    Typing your name is considered a signature
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  • To view our Privacy Policy please head to:

    https://drive.google.com/open?id=1qWZAMV3zYmWNl1JVXNs3uEUhQm972fIC

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