Greek Dance Adult Class: Enrolment Form
Fill out the form carefully for registration
Your Name
*
First Name
Last Name
Date of Birth
*
/
Day
/
Month
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Level of Greek Dancing
*
Please Select
Absolute beginner – never danced before
Beginner – familiar with a few basic steps
Intermediate – comfortable with common dances like Kalamatiano, Tsamiko, etc.
Advanced – experienced with regional styles and faster-paced dances
How did you hear about us?
*
Please Select
Facebook Post
Google search
Local library
School Newsletter
Word of mouth
Public notice board
Other
MEDICAL RECORDS
Do you have any medical conditions we should be aware of?
*
Please Select
YES
NO
If you answered "YES" above, please advise of any medical conditions we should be aware of:
EMERGENCY CONTACT
*
First Name
Last Name
Relationship to student
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
PERMISSION
PHOTOGRAPHY/MEDIA RELEASE
*
I give permission for Greek School Central Coast to take photos or video recordings during the class for promotional or archival purposes.
No, I do not give permission.
WAIVER AND RELEASE OF LIABILITY
I, the undersigned, acknowledge and agree to the following: 1. I understand the nature of the activity and confirm that I am physically and medically fit to participate. 2. I understand that participating in dance activities involves physical movement and exertion that may pose a risk of injury, including but not limited to strains, sprains, falls, or other physical harm. I voluntarily assume all such risks associated with my participation. 3. I confirm that I have no known physical or medical condition that would prevent my safe participation in this activity. I agree to inform the organisers of any relevant medical condition prior to participating. 4. I hereby release and hold harmless Greek School Central Coast, its instructors, volunteers, staff, from any and all claims, liabilities, demands, actions, or causes of action that may arise out of or relate to any injury, damage, or loss sustained by me during or in connection with my participation in the dance classes. 5. In the event of an emergency, I authorise the organisers to seek appropriate medical attention. I understand that I am responsible for any associated costs.
*
I have read and agree to the above waiver and release of liability.
Signature
*
Date
*
-
Month
-
Day
Year
Date
*
prev
next
( X )
GREEK DANCE CLASS - EARLY BIRD PRICING
$
99.00
AUD
Booking Fee
$
0.99
AUD
Credit Card
PAYMENT
SUBMIT
SUBMIT
Should be Empty: