Gift Certificate Class Registration

"Please complete this form to register for the class for which you would like to use your gift Certificate. Thank you."

Which class would you like to book?*
Class Date*
Participant's Name*
First Last
If a couple, 2nd participant's name
First Last
Mobile Phone*
Email Address*
Media Permission*
I give permission for any photographs and/or video recordings of me / us / my child, named above, taken by or on behalf of Penrith Ballroom Dance, to be used for the purpose of promoting, advertising, and marketing their classes and activities, in any digital or printed media, including but not limited to websites, social media, flyers, posters, and advertisements, with no entitlement
- Permission granted
- Permission Not Granted
Terms and Conditions*
I have read and agree to the published Terms and Conditions.
CAPTCHA

Unit 7
42-44 Abel Street
Penrith