GAQ Dance Community - Term 4 Registration
Classes: Every Sunday from 17th November to 15th December 2019
Location: 59 Mortimer Road, Acacia Ridge 4110

** Please note if the student would like to perform, they will need to attend 80% of the classes **
Student Name *
Your answer
Email *
Your answer
Primary Contact Number *
Your answer
Date of Birth *
Your answer
What class will you attend? *
Cost: $5 per class
Emergency Contact Information
Emergency Contact Name *
Your answer
Phone Number *
Your answer
Relationship (with your emergency contact) *
Your answer
Image Release
I hereby consent and agree that Gujarati Association Queensland (GAQ) has the right to take or use photographs and videos during classes and performances. GAQ will be able to use these in any or all of the promotional and advertising material of Gujarati Association Queensland *
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