ENROLMENT - INSIDEOUTSIDE DANCE Join the IO Crew! Save a tree and register your enrolment below. Registration "*" indicates required fields Applicant DetailsName of student* Mobile Email* Age of student - DOB* Day Month Year NDIS NumberPostal address:* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Name & number of Contact person or next of kinName of Contact Person* Contact Person's Number*Contact Person's Email* Which venue(s) would you like to attend?*1. 2. 3.What classes are you interested in? Tick as many as you like and please place numbers 1-5 in the box, 1 means most interested, 5 is least interested. We will add you to the roll from venues above and interest, after completing your trial please contact us via phone or email to confirm which classes you would like to continue or if you decide you do not want to continue so we can update our system* Hip hop, street and urban Contemporary/Jazz Drumming Drama Media Information: We take photographs and videos of all our classes to use for social media and publicity purposes. Unless we are notified student agree to be in class photos and videos taken during class time or performances. Access RequirementsDo you have any medical, disability, dietary, welfare, wellbeing or access requirements you would like us to be aware of?* Yes No If yes, please specify: Please specify any allergies here:In case of EmergencyIn case of emergency, I give permission for appropriately trained persons to administer medical treatment. Incase of such an emergency, please contact;Name: PhoneAlternate PhoneSupport WorkerIf you need to be accompanied by a support worker please give the person’s name and contact details here. There will be no charge for a support worker to accompany you.Support Worker Name: Phone Alternate PhoneWill you be paying with NDIS? Yes No If you are a plan manager we will send invoices to YOU and your NDIS provider, please supply name of plan manager and email address Your NDIS provider Yourself/Guardian Plan manager name and email I realise that my enrolment will not end until I notify Inside Outside Dance that I do not want to attend classes anymore by email.* By returning this form you agree you have read and understand this condition. Further InformationInsideOutside Dance looks forward to working with you. Please submit this form to - dance@insideoutsidedance.com or phone Rosanne on 0428156688 if you have any questions. 83991 InsideOutside Dance Registration Download Registration Form InsideOutside Dance NDIS Service Agreement Download NDIS Service Agreement
