Dance Class Enrolment & Service Agreement Form

Please note each year current and new participants are required to fill out an enrolment and service agreement. We will require your current details and/or our terms and conditions may have changed. If we do not have an enrolment form for you, unfortunately you will not be able to participate in class due to regulations.

Participant Details

Please Note: In 2020 we will be piloting the expansion of our dance and fitness classes offerings in Ballarat to people with Down syndrome and intellectual disability. All of our other classes are Down syndrome specific.

Contact Details

Site Location

*Various age-based classes are available NOW through our VIRTUAL online classes due to COVID-19. For now 1- Choose either a site closest to you if in Victoria, Australia. Or 2- select VIRTUAL classes ONLY if no sites applicable to you (overseas, interstate, too far from a current site)
Please note: This excludes Performance Company, which is accessed by audition.

First Aid Permission

If you have ticked ‘NO’ above, you are required to ensure that you or a nominated Guardian is readily available at each class to take the appropriate action.

e.motion21 has a nut free policy at all of our classes and performance venues. Participants, parents and e.motion21 staff are prohibited to bring any food that contains nut products to these venues. Although there is a prohibition on nut products being bought to venues, e.motion21 takes no responsibility for any pain, suffering, loss or damage caused by the prohibition being breached.

Teaching the participant

Agreed code of conduct

  1. Behave in a way that is aligned to e.motion21’s core values of care, fun, learn and respect and follow e.motion21 class rules.
  2. Attend class on time; or notify your absence through our online portal as per NDIS cancellation guidelines to avoid being charged any fees
  3. Support e.motion21 policies and procedures.


  • has zero tolerance for child abuse
  • actively works to listen to and empower children
  • has systems to protect children from abuse, and will take all allegations and concerns very seriously and responds to them consistently in line with the organisation’s policies and procedures
  • is committed to promoting physical, emotional and cultural safety for all children
  • is committed to providing a safe environment for all children

At any stage during your interaction with e.motion21 should you wish to use the services of an advocate please contact the Office of the Public Advocate on 1300 309 337 or via their website on

The Victorian Public Advocate is empowered by law to promote and safeguard the rights and interests of people with a disability.

There are a number of other specific advocacy agencies funded through the OPA. They can be found on the Department of Human Services, Victoria website – please click on the link below: providers/disability/protecting-rights/disability-advocacy/disability-advocacy- organisations


e.motion21 is committed to ensuring the privacy of all participants, staff and volunteers. All information is stored and used in accord with all legislative requirements. For more information please click here.

e.motion21 welcomes feedback from the participant or participant’s representative and seeks to resolve any concerns a participant may have, in a timely and professional manner.

If the participant wishes to give e.motion21 feedback or has a dispute, the participant can talk to the Volunteer Site Coordinator or a staff member at Kew Head Office on 03 9854 7100 . Or complete our online Feedback Form here

If the participant is not satisfied with the outcome they can contact e.motion21 CEO via the Kew Head Office number above.

Alternatively, the Participant can make contact with the NDIS Quality Safe Guards Commission on 1800 035 544 or by visiting the NDIS Commission website for further information.

e.motion21 will:

  • protect your privacy and confidential information
  • consult the participant and/or your parent/carer on decisions about any changes to the services provided
  • listen to your feedback and resolve problems quickly
  • treat you with courtesy and respect

Photographs, video and film footage and audio recordings

e.motion21’s vision is to enhance lives and change perceptions of Down syndrome within society through dance, fitness and performance. The use of photography, video, audio and film will be in accordance with this vision and e.motion21's core values of care, fun, learn and respect.

Under the Information Privacy Act, photographs, videos, film and audio recordings are classified as "personal information". The purpose of this consent form is to comply with the privacy legislation and enable e.motion21 to take and store photographs, video, film and audio recordings as part of its programs and the promotion thereof.

Multimedia consent

By ticking the relevant boxes below and signing this section, I agree that e.motion21 may, at its discretion, use photos, videos, voice recordings, the written version of the words spoken in videos, film and voice recordings and identify the individual using their first name only.

These can be from any of the activities we run whether its onsite or via VIRTUAL platform.

Authorised persons

I give consent for the following people to drop off and pick up the participant and also for consent to our VIRTUAL class.

Payment Terms & Fees

When you enrol the participant with e.motion21, you are making a financial commitment to pay fees for each term, plus an annual concert contribution of $35 which will be added to term 2 fees (2020 concert fee is subject to amendment due to COVID-19)

e.motion21’s programs are registered with the NDIS to provide the supports of “Community Participation in a Group Activity”. NDIS fees will be calculated in accordance with current rates as determined by the NDIS, whom set and review these prices annually. e.motion21 reserves the right to change the price of its services in accord with any changes made by the NDIA to service pricing.

If you are not being funded by NDIS, please email us at for current non-NDIS pricing.


From 1st July 2020, participants will be required to give 2 business days’ notice for a cancellation if they want to avoid paying the full fee for a cancelled service.
Note: We DO NOT accept credit card or cheque payments for our class fees
1- Direct Debit details:
(6 digits only)
Note: we do not accept credit card or cheque payments

This Service Agreement is made for the purpose of providing supports under the Participants’ National Disability Insurance Scheme (NDIS) plan.

The Parties agree that this Service Agreement is made in the context of the NDIS, which is a scheme that aims to:

  • support the independence and social and economic participation of people with a disability; and
  • enable people with a disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports.

The supports described in this Service Agreement are reasonable and necessary supports specified in the statement of supports in the Participant’s NDIs current plan (under section 37 of the National Disability Insurance Scheme Act 2013). e.motion21 will adhere to the National Disability standards.

  • The Participant’s NDIS plan is expected to remain in effect during the period the supports are provided; and
  • The Participant will immediately notify the Provider if the Participant’s NDIA Plan is replaced by a new plan or the Participant stops being a participant in the NDIA.

Changes to this Service Agreement

If changes to the supports or their delivery are required, the Parties agree to discuss and review this Service Agreement. The Parties agree that any changes to this Service Agreement will be in writing, signed, and dated by both Parties.

Ending this Service Agreement

Should either Party wish to end this Service Agreement they must give one months’ notice, in writing with an email to If either Party seriously breaches this Service Agreement the requirement of notice will be waived.

From 1st July 2020, participants will be required to give 2 business days’ notice for a cancellation if they want to avoid paying the full fee for a cancelled service

Please note for planned cancellations or if the participant is unable to attend for a longer period for whatever reason, please advise via email the office at 

Participants will be charged the full NDIS rate and only if their package allows partial funding by NDIS they need to cover the balance.

e.motion21 will send the participant an invoice for those supports for the participant to pay. The Participant will pay the invoice within 7 days.


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Last updated: 10/1/2020 (v2020.1)