Dance Revolution 2021 Participation Consent Form

    Please read carefully then write your name at the bottom of the page, this shows you understand the aim of the participation and agree to take part

    I understand that I am enrolled with The Palace Dance Studio to complete The Dance Revolution Programme



    I agree that:
    - I’ve had an opportunity to ask questions and my questions have been answered

    My information, as listed below can be shared with the Ministry of Social Development under this programme:
    - My name
    - My date of birth

    The summary of results of the programme which include attendance, progression to other activities and feedback on the programme.

    Information is shared with the Ministry of Social Development for the purpose of evaluating the success of The Dance Revolution Programme.
    - I understand that my participation in the programme is voluntary
    - My information will be stored securely in accordance with the Privacy Act 1993
    - Any personal information will not be shared further, unless I give consent.