About The Member

First Name *

Last Name *

Date of birth *

Age *

Gender Identity

School

Grade

Phone *

Email *

About The Music

What Kind of Music Do you Love?

Name 3 songs you are loving right now

Name your favorite artist or band

What themed night would you most want to attend?

If you could suggest a theme night, what would it be?

About Dancing

Have you danced before?

How did you hear about Whakamana?

Parent Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Relationship to Member

Parent/Guardian Email *

Parent/Guardian Phone *

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship

Membership Plan Selection

Select Your Membership Plan *

Founder - FREE -

Solo Member $5/mo

Duo membership $8/mo

Family Pack (3+) $12/mo

Upload Your Selfie

Please upload a clear, recent photo of your face. This will be used for your member ID card. No filters please!

Upload Selfie *

Click to upload

PNG, JPEG or JPG

Agreements

Code Of Conduct *

I will watch the Whakamana Code of Conduct video and agree to all rules once I receive the link - email and text message sent automatically you dont need to do anything-

Parental Waiver *

A parent or guardian has completed and signed the Whakamana Parental Consent & Release of Liability Agreement

Photo/Video Release *

I give permission for Whakamana Dance Club to use photos or videos taken at events for promotional purposes. (Check to opt OUT if you do NOT give permission)

Age Confirmation *

I confirm that the member is between 13 and 18 years of age

By submitting this application you confirm that all information provided is accurate and that a parent or guardian is aware of this application.