Rekindling Registration 2018 Question Title * 1. I would like to register for Rekindling in Charleville Thursday Island Darwin OK Question Title * 2. Contact Information Full name * Address * Address 2 Suburb * State * Postcode * Email Address * Phone Number * OK Question Title * 3. Date of birth OK Question Title * 4. Gender Male Female Other OK Question Title * 5. I am: Aboriginal Torres Strait Islander South Sea Islander Mixed OK Question Title * 6. Please specify the name of your Aboriginal/Torres Strait language group (if known) OK Question Title * 7. Parent / Guardian Details Full Name Email Address Phone Number OK Question Title * 8. Name of School OK Question Title * 9. In the interest of confidentiality, media and photography, please indicate if you are: Ward of the state Living in foster care OK Question Title * 10. Describe any arts or cultural activities that you've been involved in or that you'd be interested in OK Question Title * 11. Do you have any pre-existing injuries, health problems, learning disabilities? If yes, please state OK Question Title * 12. Have you participated in a Bangarra workshop before? Yes No OK Question Title * 13. Have you attended a Bangarra performance before? Yes No OK Question Title * 14. What is your t-shirt size? Mens XS Mens S Mens M Mens L Mens XL Womens XS Womens S Womens M Womens L Womens XL OK Question Title * 15. Please upload a photo of your face so that we know who you are! Photo of just yourself, head and shoulders visible. DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Photo of just yourself, head and shoulders visible. OK Question Title * 16. I have downloaded and read the release, permission & disclaimer form Yes OK DONE
