To be completed by applicant.

Question Title

* 1. I would like to register for the Rekindling Program in:

Question Title

* 2. About You

Question Title

* 3. Date of Birth

Please complete in the format DD/MM/YYYY

Question Title

* 4. Gender

Question Title

* 5. Home Address

Question Title

* 6. I am:

Question Title

* 7. Please specify the name of your Aboriginal and/or Torres Strait Islander language group(s) (if known).

Question Title

* 8. Do you have any pre-existing injuries, health problems, or learning disabilities?

Question Title

* 10. Please upload a photo of your face so that we know who you are!

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
No file chosen
To be completed by a parent/guardian.

Question Title

* 11. Parent/Guardian Details

Question Title

* 12. Would you like to subscribe to Songlines newsletter?

Question Title

* 13. In the interest of confidentiality, media and photography, please indicate if your child is:

Question Title

* 14. Please confirm you have read and agree to the terms outlined in the Permission & Disclaimer Form.

Collection Notice
The information you provide in this form is personal and sensitive. This form allows us to make an assessment, and provide you with access to our Rekindling Youth Program. We respect your privacy and will treat the information you provide to us with utmost confidence. In order to provide our Rekindling Youth Program, we may be required to share necessary personal information with relevant venues, or adults involved in the program. We collect, use, disclose and store your personal and other information in accordance with our privacy policy, which you can view here.
Bangarra Dance Theatre
02 9251 5333
bangarra@bangarra.com.au

T