Single Adult Dance Class Registration
Full Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Type of class attending
Please Select
Adult Ballet
Adult Hip Hip
Adult Popping
Adult Barre Fitness
Date of Class
-
Month
-
Day
Year
Date
Waiver of Liability
Indicated in the space below are any health problems or conditions of which the studio should be aware (such as heart, back, medical, allergy, muscular, pregnancy, diabetes, epilepsy, chemical or neurological condition, special medication, knee/kidney/shoulder problems, etc.). I understand that risk of injury is inherent in any physical activity and I knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, administrators, and executors, herby waive and release En Pointe Dance & Fitness, individually and , En Pointe Inc. and its staff from any and all claims or damages of any kind arising out of my participation in the exercise and/or dance program of En Pointe Dance & Fitness. I certify that I am improper physical condition to participate in the exercise/dance program and that I have been examined by a licensed physician and found to be in proper physical condition to participate in said program. I, the undersigned, do herby authorize En Pointe Dance & Fitness or her designated agents (being teachers or administrators employed by En Pointe Dance & Fitness.) to obtain medical treatment for myself in emergency situations if needed. I understand that I am responsible for any medical expenses and that the absence of health insurance does not make release En Pointe Dance & Fitness responsible for payment of medical expenses. This authority includes the power to authorize any and all treatment deemed necessary under the circumstances by a licensed physician. This power is in essence a power of attorney and shall remain in effect for one year from the date signed below. Permission is granted to En Pointe Dance & Fitness to use photographs of myself or my child for publicity purposes. I have read, understood and agree to be bound by the above statement and am aware that a copy of En Pointe Dance & Fitness Studio Policies and Dress Code are available at enpointedanceandfitness.com
Date
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Month
-
Day
Year
Date
Health Concerns
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Adult Dance Class - Drop In
Adult Dance Class Drop In.
$25.00
$
25.00
Quantity
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Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
ACH Bank Transfer
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