Pulse GWS Primary Dance Ensemble 2022

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This ensemble rehearses weekly at Nepean Creative and Performing Arts High School on Thursday afternoons from 4:00 pm to 5:30 pm and is open to Years 5 and 6 students currently enrolled in a NSW public school.

Applications close at 4pm on Tuesday 15 February 2022 (Term 1 Week 4) and auditions will be held on Thursday 17 February 2022 (Term 1 Week 4) from 3:45 pm to 5:30 pm at Nepean Creative and Performing Arts High School.

For the audition, students will participate in a dance class and be taught choreography (they will not need to prepare a solo).

Please note, in addition to this form, both the PARENT PERMISSION FORM (bit.ly/PPFprdan22) and SCHOOL ENDORSEMENT FORM (bit.ly/SEFprdan22) must be completed and submitted to the email address indicated on the forms.

Membership fees for the 2022 Pulse GWS Primary Dance Ensemble are $240 for the year.

For further information, please contact the ensemble coordinator Lucia Parkhill (lucia.zoller2@det.nsw.edu.au).

Email *

Student first name *

Student surname *

Student gender *

Female

Male

Prefer not to say

Other:

2022 School *

Student School Year 2022 *

Year 5

Year 6

Student Date of Birth *

YYYY

Student Home Address *

Student Home Suburb *

Student Home Postcode *

Student Home Phone

(if applicable)

Student Mobile Phone

(if applicable)

Student Contact Email Address *

Name of School Contact Teacher

Name of School Principal

Dance experience *

Please list any relevant dance experience

Parent First Name *

Parent Surname *

Parent Mobile Phone *

Parent Email Address *

Parent Relationship to Student *

Mother

Father

Grandparent

LegalGuardian

Other:

Additional Parent First Name

(optional)

Additional Parent Surname

(optional)

Additional Parent Mobile Phone

(optional)

Additional Parent Email Address

(optional)

Additional Parent Relationship to Student

(optional

Mother

Father

Grandparent

Legal Guardian

Other:

Clear selection

Student Medicare Card Number *

Please include position on card

Private Medical Insurance Information

(if applicable)

My child has the following special needs or medical conditions: *

If none, please write N/A

My child has the following allergies: *

If none, please write N/A

My child has an Anaphylaxis and/or Asthma Action Plan *

If your answer to this question is yes, a copy of the action plan MUST be directly emailed to the ensemble coordinator on submission of this application.

YES, Anaphylaxis only

YES, Asthma only

YES, both Anaphylaxis and Asthma

My child currently takes the following medication (please provide as much detail as possible): *

If none, please write N/A

Emergency Contact Information *

Please provide information of TWO emergency contacts who are not listed in parent section of this application. Please indicate their name, contact details and relationship to the child.

Application Agreement *

Please ensure all boxes are ticked prior to submitting.

I understand that, in addition to submitting this online form, I need to complete and submit the PARENT PERMISSION FORM and SCHOOL ENDORSEMENT FORM.

I understand that a fee is payable to be a member of the Pulse GWS Primary Dance Ensemble.

I understand that, to be a member of the Pulse GWS Primary Dance Ensemble, the student must attend all scheduled rehearsals and performances, and must abide by the NSW Department of Education's behaviour code.

Required

A copy of your responses will be emailed to the address you provided.

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