Register with Jolt Dance

Please make sure you are familiar with the terms and conditions   (opens in a new window).

In addition to dancer and contact information, you can upload to us
  • A behavioural plan
  • A seizure plan
  • A recent photo of the dancer
Please have these documents handy, if appropriate. They can be uploaded below.
Required fields are marked with a red asterisk *

Dancer information

Name:*
Date of birth:*
Email (if applicable)
Phone (if applicable):
Address:*
Racial identity - I identify as:

Main contact

Name:*
Relationship to dancer:*
Email:*
Contact phone:*

Secondary contact (optional)

Name
Relationship to dancer
Email
Contact phone

Invoices* at least one required

Please specify the email address to which we should send invoices (up to 2):
*

Other

If you use a taxi service, what company do you use?
Can Jolt use images or video taken from activities that include this dancer to help to support and promote our mahi?
*
Is there any other information we may need to know (need for one-on-one support, allergies, medication or behavioural issues)?

Behavioural plan

(optional) - If appropriate, please provide a behavioural plan document

Seizure plan

(optional) - If appropriate, please provide a seizure plan document

Photo

(optional) - you can help our tutors get to know the dancer by supplying a photo

I have read, understand, and agree to the

terms and conditions   (opens in a new window)

I agree