Participant's name *

First Name

Last Name

Emergency Contact Name *

First Name

Last Name

Secondary Emergency Contact Name *

First Name

Last Name

Photos and videos *

We will be taking photographs at the event in order to showcase and promote our activities. Please indicate whether you consent to your child's image being displayed for these purposes. Please note: We do not list the participants' names.

Yes, I give permission for photos that include my child to be displayed on social media, websites and email communications of Nook Dance Centre and The Philosophy Club.

No, I do not give permission for photos that include my child to be displayed on social media, websites and email communications of Nook Dance Centre and The Philosophy Club.

Health and safety agreement *

'Dance your Mind' Holiday Program participants participate at their own risk. 'Dance your Mind' is not liable for any injury sustained during the program. In the case of a medical emergency, our program leaders, Tammy and Michelle, reserve the right to call an ambulance at the expense of the participant's parent/guardian. By submitting this form you confirm that all the information provided is accurate.

I have read and understood the health and safety agreement.