Panaga Club - Panaga Dance Centre (P.D.C.) Tippy Toes Membership registration form
Before filling in this form, please ensure that you are a Panaga Club member.

By filling in this form you express interest in following Tippy Toes dance classes at the Panaga Club through the P.D.C. Once a space is available, you will be notified.

Once a place has been allocated to you, you will have to fill in an acceptance form to secure the place and authorize the club to deduct the class fees.

Note: in case you want to register multiple persons, please fill in a separate form per person!
Name of Student *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Male/Female *
Apply For (please tick, min. age to register is 6 months prior to minimum age for starting) *
Required
Previous dance experience or R.A.D. Grades
Your answer
Principal Member’s Name (first name, surname) *
Your answer
Dept/Coy *
Your answer
Membership number *
Your answer
Spouse Name
Your answer
Contact number *
Your answer
Email address *
Your answer
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
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