Xtreme Hip Hop with Nicole

HI THERE.

Welcome to Xtreme Hip Hop with Nicole! I just need a bit of information from you before we get started on this fitness journey together.
Basic Information
Full Name*

First NameLast Name
Cell Phone Number*
Email*
example@example.com
My Facebook profile name is FB Name*.
My Instagram username is IG Name*.
Home Address*

Street Address

Street Address Line 2 (if needed)

CityState

Zip Code
Class Selection
Class Payment Rules and Instructions
Payment for each class is due to Nicole via Venmo PRIOR TO CLASS to secure your step and/or spot.
1. Please use your smart phone's camera to scan the below QR code to find me on Venmo, or simply open the Venmo app and search by my username (@nicollleann)
2. In the "What's it for?" box in the Venmo payment screen, type in "XHH class" followed by the date(s) in which you would like to attend
3. Submit your payment!
Legalese
City of Providence - Waiver of Liability [Please fill in, sign, and scan this form to wilson.nicoleann@gmail.com in advance of your first class!]
Xtreme Hip Hop with Nicole - Waiver of Liability*
I hereby agree and acknowledge that I consent to waive the liability of Xtreme Hip Hop with Nicole ("Fitness Provider") for any tangible or intangible damages, loss of property, or loss of life that may occur during my participation in the fitness activities (hereinafter, "Fitness Activities") provided by the Fitness Provider following the terms provided herein. These Fitness Activities include, but are not limited to, the following: cardiovascular conditioning and training, muscle strength training, endurance training, and other various fitness activities. ASSUMPTION OF RISK I fully understand that participating in the Fitness Activities may involve physical or psychological injury, including but not limited to damages, illness, paralysis, emotional loss, or even death. With full knowledge of the risks, I voluntarily participate in the Fitness Activities. COVENANT NOT TO SUE I will not sue or start any lawsuit or other legal action against the Fitness Provider. I acknowledge and will hold harmless the Fitness Provider for any errors and omissions of any entity or party conducting the Fitness Activities. INDEMNIFICATION I hereby agree to indemnify and hold harmless the Fitness Provider against any and all legal claims and demands for damages, liability, and attorney's fees brought by me or anyone on my behalf. I agree to reimburse if any of these expenses were incurred. REPRESENTATION I am over 18 years of age and I declare myself to be medically and physically capable of participating in the Fitness Activities. GOVERNING LAW This Fitness Waiver shall be governed by and construed under the laws of Providence County, Rhode Island. SIGNATURE In signing this waiver and release, I acknowledge and represent that I have read and understand the foregoing and hereby sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreements have been made; and I hereby execute this waiver and release for all valuable consideration, intending to be bound by the same.
Signature*

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Which classes do you want to sign up for this month?
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Sunday, November 24ALL LEVELS WELCOME | Roger Williams Park Gateway Center | 10 a.m.
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HI THERE.

Basic Information

Class Selection

Class Payment Rules and Instructions

Legalese