DANCE club REGISTRATION

Please complete all the fields in this form, read the membership declaration, then enter your first and last name and press submit (at the bottom of the form) to register your child in DANCE club:

Dancer's Surname*

Dancer's First name*

DOB*

M/F*

Address Line 1*

Address Line 2*

City*

School/Preschool*

Parents Name*

Mobile No*

Phone*

E-Mail*

Emergency Contact Details*

  Medical Information:

 

MEMBERSHIP DECLARATION 1. Accuracy: The details set out in this Membership Form are true and correct. If they change I acknowledge that I am required to notify DANCE club of the changes in writing as soon as possible after they occur. If the details provided are not true or are misleading I acknowledge my membership may be terminated at the discretion of DANCE club. 2. Bound by Rules: I will be bound by the constitutions, regulations, policies, manuals, guidelines and reasonable directions of DANCE Club. 3. Accept Risk of Dancing: I have voluntarily accepted and assumed the inherent risk of danger and injury in Modern Dance. 4. No liability: I will not hold DANCE club or their respective officers responsible or any claims, losses and expenses and costs (including legal costs) which may arise from or in connection with my membership and/or participation in any activity authorised or recognised by DANCE club except in the case of gross negligence or a wilful act or omission on the part of DANCE club. 5. Indemnity: I indemnify DANCE club from all claims, losses and expenses (including legal costs) suffered or incurred at any time as a result of, or resulting directly or indirectly from, my failure to observe the constitutions, regulations, policies, manuals, guidelines and reasonable directions of DANCE club. 6. Medical Declaration: I am medically and physically fit and do not suffer from any injury, disease or condition, either physical or mental, that would affect my ability to safely participate in any authorised or recognised activities of DANCE club. If I am unsure about this declaration, or suffer from such a condition I have either listed it on this form or I am aware that I must bring it to the attention of DANCE club. 7. Privacy: I agree that DANCE club can collect, hold, use and disclose my personal information as provided on this Form (and any updated or additional personal information DANCE club obtains from me including any photo or other record of my image) for the purposes of: a. Processing my application for membership including notifying DANCE club of the information on this form for the purposes of DANCE club compiling a register of members, compiling a national database of members and participants, and for requesting me to renew if my membership lapses; b. Putting my name and contact information on DANCE club’s membership list for use by other members of DANCE club; c. Publishing any of my achievements in DANCE club newsletters and on their websites; d. Selecting and publicly naming competitors and teams to represent DANCE club at events; e. Providing me with information and activities relating to DANCE club and other Dancing matters; f. Including my photograph or other imagery on DANCE club website, in newsletters, annual reports, or similar official publications; g. Enabling DANCE club to contact me with information about the products and services of DANCE club sponsors or funders (unless I have opted out of receiving such information on the Membership Form); h. Enabling DANCE club to comply with any statute, regulation, by-law or other regulatory instrument that requires collection or disclosure of personal information; i. Retaining the information provided on this form if my membership lapses (as an inactive member) for a maximum period of three years for the above purposes; and j. Any other purpose I agree to in writing. 8. Use, Security and Access: I understand that my personal information will only be used for the purposes listed in paragraph 7, and that: a. My personal information will be held securely; b. I will have access to my personal information under the Privacy Act; c. My personal information will be corrected upon request. 9. Continued Membership: I understand that upon payment of my membership fee(s), if I am accepted to membership, I will become a member of DANCE club and and that by paying such fee(s) by the due date(s), I will continue to be a member of DANCE club for the duration of my Membership as specified on this form , unless I resign or my membership is terminated. 10. Interpretation: Every reference to “I” and “my” in this document includes the dancer and the parent/guardian! caregiver of the dancer (if applicable). Copies of constitutions, regulations, policies, manuals and guidelines of DANCE club can be obtained by contacting DANCE club. 

 

PARENT/GUARDIAN/CAREGIVER CONSENT FOR DANCERS UNDER 18 YRS: I am the parent/guardian/caregiver of the dancer who is under 18 years of age. I have read and understood this form and the Membership Declaration. I consent to the dancer’s application for membership on the basis set out in this form and the Membership Declaration. I also consent, or am authorised to consent, to the emergency contact details specified in this form being held by DANCE club for the purposes of contacting the person(s) named in an emergency. If I am not a member myself, I also consent to my name and contact details as set Out below, being collected, held, and used as the dancer’s parent, guardian or caregiver in accordance with the purposes set out in paragraph 7 of the Membership Declaration as if I were a member of DANCE club. 

 

Guardian Surname*:

Guardian First name*:


Press submit to confirm your registration / consent / membership declaration.

 

 

 

 

 

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