Event Registration Form
Attendee Information
Please fill name and contact information of attendees.
Your Name - Nombre
*
First Name
Last Name
Contact Number - Número De Teléfono
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Date of Birth - Fecha de Nacimiento
-
Month
-
Day
Year
Date
Emergency Contact Name and Number- En caso de Emergencia Nombre y Telefono
What classes are you attending? - A que clases se está registrando?
8/1 Zumba w/Sunshine 8pm
8/2 Zumba w/Karina 7pm
8/3 Zumba w/Sunshine 1pm
8/5 Zumba w/Sunshine 10am
8/5 Bachata 7pm
8/5 Zumba w/Karina 8pm
8/6 Hip Hop 6pm
8/10 Hip Hop 1pm
8/12 Zumba w/Sunshine 10am
8/12 Bachata 7pm
8/12 Zumba w/Karina 8pm
8/13 Zumba w/Karina 7pm
8/13 Zumba w/Karina 8pm
8/14 Salsa 7pm
8/15 Zumba w/Karina 7pm
8/15 Zumba w/Sunshine 8pm
8/17 Zumba w/Karina 9am
8/17 Zumba w/Sunshine 1pm
8/19 Zumba w/Sunshine 10am
8/22 Zumba w/Sunshine 8pm
8/24 Zumba w/Sunshine 1pm
8/26 Zumba w/Sunshine 10am
8/26 Bachata 7pm
8/26 Zumba w/Karina 8pm
8/27 Zumba w/Karina 7pm
8/27 Zumba w/Karina 8pm
8/28 Salsa 6pm
8/28 Zumba w/Karina 7pm
8/28 Zumba w/Karina 8pm
8/29 Zumba w/Karina 7pm
8/29 Zumba w/Sunshine 8pm
8/30 Step Class 7:30pm
8/31 Zumba w/Karina 9am
8/31 Zumba w/Sunshine 1pm
What classes are you attending? - A que clases se está registrando?
9/9 Bachata 5pm
9/9 Zumba w/Karina 8pm
9/10 Zumba w/Karina 8pm
9/11 Zumba w/Karina 7:30pm
9/12 Zumba w/Sunshine 8pm
9/14 Zumba w/Karina 9am
9/14 Zumba w/Sunshine 1pm
9/16 Bachata 5pm
9/16 Zumba w/Karina 8pm
9/17 Zumba w/Karina 8pm
9/18 Salsa 6pm
9/18 Zumba w/Karina 7:30pm
9/19 Zumba w/Sunshine 8pm
9/21 Zumba w/Karina 9am
9/21 Zumba w/Sunshine 1pm
9/23 Bachata 5:30pm
9/23 Zumba w/Karina 6:30pm
9/24 Zumba w/Karina 8pm
9/25 Salsa 6pm
9/25 Zumba w/Karina 7:30pm
9/26 Zumba w/Sunshine 8pm
9/27 STEP class 7pm
9/28 Zumba w/Sunshine 1pm
9/30 Bachata 5:30pm
9/30 Zumba w/Karina 6:30pm
What classes are you attending? - A que clases se está registrando?
10/1 Zumba w/Karina 8pm
10/2 Salsa 6pm
10/2 Zumba w/Karina 7:00pm
10/3 Zumba w/Sunshine 8pm
10/4 Salsa 5pm
10/4 Bachata 6pm
10/4 Zumba w/Karina 7pm
10/5 Zumba w/Karina 9am
10/7 Bachata 6pm
10/7 Zumba w/Karina 7pm
10/8 Zumba w/Karina 8pm
10/9 Salsa 6pm
10/9 Zumba w/Karina 7pm
10/10 Hispanic Heritage Zumba 7pm
10/11 Salsa 5pm
10/11 Bachata 6pm
10/11 Zumba w/Karina 7pm
10/11 Heels Class 8pm
10/12 Zumba w/Karina 9am
10/14 Bachata 6pm
10/14 Zumba w/Karina 7pm
10/15 Zumba w/Karina 8pm
10/16 Salsa 6pm
10/16 Zumba w/Karina 7pm
10/17 Zumba w/Sunshine 8pm
10/21 Bachata 6pm
10/21 Zumba w/Karina 7pm
10/22 Zumba w/Karina 8pm
10/23 Salsa 6pm
10/23 Zumba w/Karina 7pm
10/24 Zumba w/Sunshine 8pm
10/25 Step Class 7pm
10/28 Bachata 6pm
10/28 Zumba w/Karina 7pm
10/29 Zumba w/Karina 8pm
10/30 Salsa 6pm
10/30 Zumba w\Karina 7pm
What classes are you attending? - A que clases se está registrando?
11/2 Zumba w/Karina 10am
11/4 Zumba w/Karina 8pm
11/5 Zumba w/Karina 8pm
11/6 Salsa 6pm
11/6 Zumba w/Karina 7pm
11/7 Zumba w/Sunshine 8pm
11/9 Zumba w/Karina 10am
11/11 Bachata 5pm
11/11 Zumba w/Karina 8pm
11/12 Zumba w/Karina 8pm
11/13 Salsa 6pm
11/14 Zumba w/Sunshine 8pm
11/18 Bachata 5pm
11/18 Zumba w/Karina 8pm
11/19 STEP CLASS 7pm
11/19 Zumba w/Karina 8pm
11/20 Salsa 6pm
11/20 Zumba w/Karina 7pm
11/21 Zumba w/Sunshine 8pm
11/25 Bachata 5pm
11/25 Zumba w/Karina 8pm
11/26 Bachata 6pm
11/26 Zumba w/Karina 7pm
11/27 Salsa 6pm
11/27 Thanksgiving Zumba 7:30pm
11/30 Zumba w/Karina 10am
What classes are you attending? - A que clases se está registrando?
1/7 Zumba w/Sunshine 7pm
1/8 Zumba w/Karina 4pm
1/9 Zumba w/Sunshine 5:30pm
1/13 Zumba w/Karina 5pm
1/14 Zumba w/Sunshine 7pm
1/15 Zumba w/Sunshine 4pm
1/16 Zumba w/Sunshine 5:30pm
1/21 Zumba w/Sunshine 7pm
1/22 Zumba w/Sunshine 4pm
1/23 Zumba w/Sunshine 5:30pm
1/25 Zumba w/Karina 10am
1/27 Zumba w/Karina 7:30pm
1/28 Zumba Sunshine 7pm
1/29 Zumba w/Sunshine 4pm
1/30 Zumba w/Sunshine 5:30pm
What classes are you attending? - A que clases se está registrando?
2/10 Zumba w/Karina 8pm
2/11 Zumba w/Sunshine 7pm
2/12 Zumba w/Sunshine 4pm
2/12 Bachata 5pm
2/12 Salsa 6pm
2/12 Zumba w/Karina 8pm
2/13 Zumba Sunshine 5:30pm
2/15 Valentines Day Zumba 10am
2/18 Zumba w/Sunshine 7:00pm
2/19 Zumba w/ Sunshine 4pm
2/19 Bachata 5:00pm
2/19 Zumba w/Karina 8:00pm
2/20 Zumba w/Sunshine 5:30pm
2/22 Zumba w/Karina 10am
2/24 Zumba w/Karina 8pm
2/25 Zumba w/Sunshine 7:00pm
2/26 Zumba w/Sunshine 4:00pm
2/26 Bachata 5:00pm
2/26 Salsa 6:00pm
2/26 Zumba w/Karina 7:00pm
2/27 Zumba w/ Sunshine 5:30pm
What classes are you attending? - A que clases se está registrando?
4/1 Zumba w/Sunshine 7pm
4/2 Zumba w/Sunshine 4pm
4/5 Zumba w/Karina 10am
4/8 Zumba Sunshine 7pm
4/9 Zumba w/Sunshine 4pm
4/12 Easter Zumba w/Karina 10am
4/15 Zumba w/Sunshine 7pm
4/16 Zumba w/Sunshine 4pm
4/22 Zumba w/Sunshine 7pm
4/23 Zumba w/ Sunshine 4pm
4/26 Zumba w/Karina 10am
4/29 Zumba w/Sunshine 7pm
4/30 Zumba w/Sunshine 4pm
What classes are you attending? - A que clases se está registrando?
7/8 Zumba w/Sunshine 7pm
7/9 Hip Hop 8pm
7/15 Zumba Sunshine 7pm
7/16 Hip Hop 8pm
7/19 Zumba w/Karina 10am
7/22 Zumba w/Sunshine 7pm
7/23 Hip Hop 8pm
7/26 Zumba w/Karina 10am
7/30 Hip Hop 8pm
What classes are you attending? - A que clases se está registrando?
11/9 3hr Bachata Bootcamp
What classes are you attending? - A que clases se está registrando?
12/10 Zumba w/Sunshine 6pm
12/16 Zumba w/Karina 6pm
12/17 Zumba Sunshine 6pm
12/23 Zumba w/Karina 6pm
12/30 Zumba w/Karina 6m
What classes are you attending? - A que clases se está registrando?
3/6 Heels Class w Natasha 6:30pm
What classes are you attending? - A que clases se está registrando?
5/27 Teacher Appreciation Zumba Class 6:00pm
5/30 Nora Fitness Class 11:00am
I waive the right to any legal action for any injury sustained on Karina's Choreography, LLC and Film Vision site or event and MyBumi Fund, LLC property resulting from normal class, physical activity or any other activity or event conducted by the participant before, during or after class time. I have my own medical insurance to cover any and all medical bills or related bills that may arise from the nature of the activity. I release Karina's Choreography, LLC from all financial responsibility from any expense that is incurred for any unfortunate situation that may occur. I also consent to my video being used in any images or marketing by Karina's Choreography, LLC. Renunció al derecho a cualquier acción legal por cualquier lesión sufrida en el sitio o evento de Karina's Choreography, LLC, Film Vision y la propiedad de MyBumi Fund, LLC como resultado de una clase normal, actividad física o cualquier otra actividad o evento realizado por el participante antes, durante o después del horario de clase. Tengo mi propio seguro médico o declaro que me hago responsable de cubrir todas y cada una de las facturas médicas o facturas relacionadas que puedan surgir por la naturaleza de la actividad. Libero a Karina's Choreography, LLC y los nombrados de toda responsabilidad financiera de cualquier gasto en el que se incurra por cualquier situación desafortunada que pueda ocurrir. También doy mi consentimiento para que Karina's Choreography, LLC utilice mi fotografía y video en cualquier imagen o marketing.
I agree to the statement above
Estoy de acuerdo con la declaracion
I DO NOT agree to the statement above
NO estoy de acuerdo con la declaracion
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