Form

Summer Holiday Belly Dance Program for Teens

Please Note: all personal information is strictly confidential.
Name*

First NameLast Name
Age*

MonthDayYear
Date
What School do you attend blanks*
Postcode blanks*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Do you identify as Aboriginal or Torres Straight Islanderblanks*
Do you have prior dance experience ?blanks*
Do you have any access requirements or is there anything we should be aware of blanks*
Will you be attending all of the sessions? *We recommend attending all four sessions to get the most from the course). (Please Check Boxes)*

Wednesday 3/1 1pmWednesday 10/1 1pmFriday 12/2 1pmWednesday 17/1 1pm
GUARDIAN DETAILS

Please fill out details below
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Parent/Guardian Indemnity of behalf of child/minor: I agree that I am of able body and sound mind, and understand that dancing is a strenuous physical activity. I take full responsibility for my own health and welfare as a participant in this class. I assume all risks and hazards incidental to my participation in this class, and do hereby waive, release, absolve, indemnify and hold harmless the teachers of the Global Dance Collective for any claim arising out of any injury to myself (or others) or personal loss.*

YES
I give my consent for this child/minor to attend this school holiday program.*

Yes
Signature*

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Summer Holiday Belly Dance Program for Teens