Registration for online DPA classes - general public

Dance for Parkinson's Class Registration Form

Please complete your details below to receive information on Dance for Parkinson's classes. Email details are required to receive Zoom invitation links.

Participant name *

First name

Last name

Address *

Address line 1

Address line 2

City/Suburb

State/Territory

Postcode

Mobile phone number

Home phone number

Email address *

Emergency contact name *

Relationship to participant

Mobile phone number *

I would like information on in-person Dance for Parkinson's classes

Sydney Metropolitan classes

Tick box for information on in person classes - held in Pennant Hills, Mosman, Bondi Junction, Rozelle & Kogarah

NSW regional classes

Tick box to receive information on NSW regional classes in your area

I would like to receive information about online classes

Online classes

Tick box to receive Zoom invitations to online classes

I agree to have my details held in the Dance for Parkinson's database for contact purposes and for disseminating information regarding the programme.

Tick box for consent *

Website: Dance for Parkinson's Australia

Click here for Dance for Parkinson's website