Panaga Club - Panaga Dance Centre (P.D.C.)ADULTS JAZZ 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 Jazz 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!


Sign in to Google to save your progress. Learn more
Name of student
Date of Birth
MM
/
DD
/
YYYY
Male / Female
Clear selection
Apply For
Clear selection
Previous dance experience or R.A.D. Grades
Clear selection
Principal Member’s Name (first name, surname)
Dept/Coy
Membership number
Spouse Name
Contact Number
Email address
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 *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms