Masterclass ZJ Jonathan Benoit 
  • Zumba Outdoors with Martha

    Masterclass with ZJ™ Jonathan Benoit from Canada

    Registration Form
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     Sunday June 26, 2022

    5:00pm

    Stillmeadow Elementary School

    800 Stillwater Rd Stamford, CT 06902

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  • Name of Instructor who referred you to this event:*

  • Ticket Type*
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  • Payment can be made via the following:

    Zelle : martha.oceguera@moceguera.com

    Venmo : Luv2dance-events-1

  • LIABILITY WAIVER
    This agreement is by and between Martha Oceguera (herein referred to as the licensed Zumba®️ Instructor) and 'FULL NAME' from top section of this form (herein referred to as the participant).

    By signing this agreement electronically you hereby agree to the following:
    1. I am participating in a Zumba®️ Class offered by a licensed Zumba®️ Instructor during which I will receive a cardio-dance workout following the Zumba®️ formula. I recognize that Zumba®️ requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.
    2. I understand that it is my responsibility to consult a physician prior to and regarding my participation in this Zumba®️ Class. I represent and warrant that I am physically and mentally fit and I have no medical condition that would prevent my full participation in the Zumba®️ Class. Special circumstances or known illnesses are to be reported to the licensed Zumba®️ Instructor independently before the Zumba®️ Class.
    3. In consideration of being permitted to participate in the Zumba®️ Class, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.
    4. In further consideration of being permitted to participate in the Zumba®️ Class, I knowingly, voluntarily and expressly waive any claim I may have against the licensed Zumba®️ Instructor for damages, and injury, including death, that I may sustain as a result of participating in the Zumba®️ Class.
    5. I, my heirs, or legal representative forever release, waive, discharge and covenant not to sue the licensed Zumba®️ Instructor for any injury or death caused by my voluntary participation in the Zumba®️ Class.

    I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

  • Do you voluntarily agree to the LIABILITY WAIVER'S terms and conditions stated above? (This agreement remains effective for the duration of the Zumba®️ Class.)*
  • For more information contact Martha at:

    luv2dance.events@gmail.com or 914-391-4200

    Click Here for Martha's Website

  • *COVID Safety - If you have a fever or have been in contact with someone with COVID in the past 15 days, please stay home and try one of my virtual classes.

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