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Panaga Dance Centre (P.D.C.) - Junior Ballet Lessons Registration  Form
Before filling in this form, please ensure that you are a Panaga Club member.

Please note that the minimum age to register is 5 years old. There is currently a waiting list and there is no need to fill this form again if you do not hear back immediately. Once a slot is available, you will be contacted via e-mail to secure the place and authorize the club to deduct the lesson fees.

Note: In case you want to register multiple person, please fill in a separate form per person!
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Email *
Membership Number *
Name of Student *
First and last name
Date Of Birth *
MM
/
DD
/
YYYY
Gender *
Required
Previous dance experience or R.A.D grades
Principal Member’s Name *
First and last name of parent holding Panaga Club membership
Spouse Name
Primary Contact *
Required
Primary Email Address *
Preferably email address to receive emails
Secondary Email Address *
Primary Contact Number
Mobile number to receive text messages at Whatsapp
Secondary Contact Number
Brunei mobile number to receive SMS/call
Indemnity and parental commitment
By submitting this form, I/We and/or my/our family acknowledge:
Any persons entering the Club’s property and/or using the Club’s facilities:
— do so entirely at own risk and neither the Club nor the Club’s management, volunteers or committee members, members or any employees shall be liable in any manner whatsoever for:
— any claim or damage arising or suffered either directly or indirectly from personal injury or harm whatsoever, including death, or any damage whether direct or indirect to personal or other property whatsoever, and how so ever caused.
— shall, by doing so, be deemed to indemnify the Club against any liability for damages, how so ever caused.
I have read and agree to the Indemnity and Parental Commitment / Authorisation *
Required
A copy of your responses will be emailed to the address you provided.
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