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Register with Jolt Dance
Dancer
Name *
Date of birth *
Email (dancer's own, if any)
Phone (dancer's own, if any)
Home address *
Ethnicity
— select —
Pākehā/New Zealand European
Māori
Pasifika
Asian
European
Middle Eastern/Latin American/African
Other
Ethnicity (if other)
Anything we should know — health conditions, behaviour, allergies, medication
Main contact (parent / caregiver)
Name *
Relationship to dancer *
Email *
Phone *
Second contact (optional)
Name
Relationship to dancer
Email
Phone
Invoicing
Invoice email *
Second invoice email
Other
Taxi company (if the dancer travels by taxi)
May we use photos/videos of the dancer in Jolt promotional material? *
Yes
No
Documents (optional — you can also send these later)
Photo of the dancer (max 12 MB)
Seizure plan (max 20 MB)
Behaviour plan (max 20 MB)
I have read and accept the
conditions of registration
*
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