Dance Classes Registration

Happenstance Belly Dance Classes Registration Form
Name*

First NameLast Name
Date of birth*

MonthDayYear
Date
Parent/Guardian Name

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.
Level of Experience

BeginnerIntermediateAdvanced
Medical Conditions or Allergies
How did you hear about us?

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Terms and Conditions:

By submitting this form,

I acknowledge that I have voluntarily applied to participate in dance class at a specified location and do hereby forever release from liability to indemnify and hold harmless Happenstance Belly Dance, and any of its employees/agents representing or related to the location as regards to dance/yoga classes. This release is for any and all liability for personal injuries (including death) and property losses or damage occasioned by, or in connection with any activity or accommodations for these events. The undersigned further agrees to abide by all the rules and regulations promulgated by Happenstance Belly Dance and/or the location.

I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN.

I have notified the instructors of any and all medical needs/issues that I might have. All practice is at your own risk. I also agree that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND THE CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN HAPPENSTANCE BELLYDANCE, THE LOCATION AND MYSELF, I HEREBY SIGN IT OF MY OWN FREE WILL.
Signature or Guardian's Signature, if under 18.

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Happenstance Belly Dance Classes Registration Form