Youth Pass -- Registration

*REQUIRED FIELDS

Full Name:*
Parent or Guardian:*	First Name: Last Name:
Address:*
City:*
Postal Code:*
Phone:*
Email:*
School:*
Grade:*
Hobbies:*
*Are you currently taking dance classes? Yes No**
What dance classes are you taking?
Who is your instructor?
How did you find out about the Youth Pass?* By submitting this registration form I acknowledge that I have read and agree to adhere to the restrictions of this program as noted. I also confirm that I meet the eligibility requirements. I accept responsibility for keeping Dance Victoria informed of any changes to my e-mail or snail mail addresses and furthermore, should I miss any opportunities as a result of failing to inform Dance Victoria of such changes, Dance Victoria is not responsible for extending to me any benefits or any other claims as a result of my negligence. PRIVACY Dance Victoria agrees not to trade or sell, or otherwise supply to third parties information collected by the Dance Victoria administration office provided by members of the public for the purpose of registering for a class, workshop, youth pass or other program. Our complete Privacy Policy is posted on this website. You can gain access to it by clicking here. DELIVERY Please allow ten days to receive your Youth Pass in the mail. I agree.