Contact Details

Email Address

Phone Number

Postal Address

Date of Birth

Dance Experience

Do you have any previous Dance Experience?

Please provide details

Please give us details of what type of fitness work or exercise you do, and how often?

Medical History & Past Injury Details

If you ticked any of the above please give details below:

Release From Liability & Negligence

In exchange for authority to participate in dance classes, events and performances of the NT Dance Company, I hereby grant the following release from liability and negligence. I release and hold harmless NT Dance Company and its officers, directors, employees, representatives, agents, contractors, landlords and lessees (hereafter called ‘Related Parties’) from any and all liability for injury to my person or property caused in any manner of the Related Parties by my participation in the NT Dance Company classes, events and performances. I acknowledge that the contemporary dance classes provided by NT Dance Company are physically strenuous and challenging. I understand that whilst NT Dance Company classes allow for an appropriate warm up period, participants are advised to pace themselves during the classes and take responsibility for their own health & physical safety. I acknowledge I have been advised to consult with my doctor with respect to any past or present injury, illness, cardiovascular problem or any other condition that may affect my participation in dance classes and that I knowingly execute this release from liability and negligence. I acknowledge that I may be photographed or filmed while participating in the dance classes and I hereby give permission for the use of my name and photographic likeness to be used in all forms of media for the promotion of any activity undertaken by NT Dance Company.

Print Name

Date

if under 18

If dance class participant is under the age of 18, a parent or guardian must sign on their behalf below: I hereby give consent for my child to participate in dance classes, events and performances of the NT Dance Company, I declare that I have read and acknowledge the above and that I knowingly execute this release from liability and negligence in relation to my child’s participation.

Print Name

Date

Relationship to participant

COMPANY CLASSES

DANCE CLASSES

Volunteer