Gungahlin Physie & Dance 2024 Free Trial / New Member Registration Form
Please complete this form prior to attending a trial or class with Gungahlin Physie and Dance. We offer two free trial classes to all new members so come and give physie a go with no obligation to continue or fees payable until your third class. It is a requirement of our insurance and also to manage class numbers that you have completed this form prior to your first class.

This form is required to join Gungahlin Physie and Dance and also to attend a two free trial classes. If after your trial classes you wish to continue, and prior to your third class, you are required to register with our national association, APDA, and pay your 2024 registration fee to APDA. Information on how to complete your APDA registration will be provided separately.

If you are registering more than 2 members, please complete this form again as this form allows only two registrations per form. 

Upon receipt of your form, we will respond with our 2024 Club Handbook and information on class timetables and commencement for 2024. We look forward to welcoming you to physie in 2024!
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Welcome to Gungahlin Physie and Dance - our dance family!
Parent / Guardian 1 Name *
Home Address *
Parent / Guardian 1 Contact Number *
Name of Person Responsible for Payment of Invoices (note, no fees are payable until after your second class) *
Parent / Guardian 2 Name (if applicable)
Parent / Guardian 2 Contact Number
Email Address *
Student / Dancer 1 Name *
Student / Dancer 1 Date of Birth *
Student / Dancer 1 School & Year Level at School (if applicable) *
Does Student / Dancer 1 have any Medical or Behavioural Conditions that we should be aware of that may limit their ability to participate? Please include any allergy or asthma action plan information. *
Has Student / Dancer 1 ever been enrolled in another physie club. If so, please provide what age group and year of previous enrolment. *
Student / Dancer 2 Name
Student / Dancer 2 Date of Birth
Has Student / Dancer 2 ever been enrolled in another physie club. If so, please provide what age group and year of previous enrolment.
Does Student / Dancer 2 have any Medical or Behavioural Conditions that we should be aware of that may limit their ability to participate? Please include any allergy or asthma action plan information.
Is there any custodial matters that we should be aware of in relation to your child / children?
Do you give permission for Gungahlin Physie and Dance to use images of you / your child on our website, social media and in other promotional material? Please note, while restrictions are put in place at our venue, competitions & classes around photography, we cannot control or prevent other people inadvertently photographing you or your child and using such photos in social media etc. *
How did you hear about Gungahlin Physie & Dance? *
By completing this form, you / your child / children agree to abide by all rules, policies, guidelines and directions provided by officials of Gungahlin Physie and Dance and APDA at all times. Please enter your name and date below to accept these terms and conditions. *
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