InsideOutside Disco

Monthly Registration

Provider number: 4050039182

Contact Details:

Rosanne Stuart • 0428 156 688 • Email: dance@insideoutsidedance.com

In Care Central – Georgia Borchert • 0428 997 774 • Email • georgia@incarecentral.com.au

Entry Fee for all Disco Registrations is - $20 per participant.

$10 for support worker if they request pizza and a drink, support workers are free if they do not want to be included in catering.

Everyone registering and not attending on the night will be invoiced.

Name of participant:

Phone number:

Email Address:

Is the participant gluten free?

Yes

Name of next of Kin:

Phone number of next of kin

Email address of next of kin

Name of the Parent/Support worker:

Phone number of the Parent/Support worker:

Email address of the Parent/Support worker:

Would your support worker/parents like to purchase a drink and pizza for $10 -

Yes

If yes, is the Support person gluten free?

Yes

If yes who is responsible for payment?

Participant

Support Worker

N/A