World Record Setting Siva Samoa with Pacific Dance NZ
Event Timing: Thursday 28th October, 2021: 7pm - 8pm
Zoom Call - Details will be sent through to you on registration
Contact us at E: or E:
Sign in to Google to save your progress. Learn more
Email *
Name *
How many people are you registering for this zoom class? *
Where are you located? *
By registering for this event I confirm my agreement to being filmed and/or interviewed by Pacific Dance New Zealand. I understand that the rights to any resulting images or text now belong to Pacific Dance Fono Trust & Pacific Dance NZ to use as it wishes in promotional materials and activities such as web pages, advertising and publications. Having registered for this event, I am permitting Pacific Dance Fono Trust & Pacific Dance NZ to use my image/footage and/or text for a period of five years from the date of signing. I now waive all personal rights to object to the use of my image, name or personality in connection with any text or image of me in Pacific Dance Fono Trust & Pacific Dance NZ promotional material. I accept that, by retaining this releasee form signed by me, Pacific Dance NZ can be assured that it has my permission to proceed *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pacific Dance New Zealand. Report Abuse