Dance Fitness
Friday classes
£6.00 a class
Can pay on arrival: Cash, Card, Bank transfer
Name
*
First Name
Last Name
Email
*
All information will be sent via email
Phone Number
*
-
Area Code
Phone Number
Date of birth
*
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Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency contact name
*
First Name
Last Name
Emergency contact number
*
-
Area Code
Phone Number
Are there are medical conditions, disabilities or diagnosed mental health conditions we should be aware of?
*
Which session are you interested in?
*
9:30-10:30 South Brent Methodist Church
19:00-20:00 South Brent Recreation Ground
Photo consent (for advertising purposes)
*
Yes
No
Any Queries you may have/extra information you would like to tell us...
Terms and Conditions:
By submitting this form, I acknowledge that participation in dance classes involves physical activity and I hereby release the dance studio and its instructors from any liability for injuries or accidents that may occur during classes or events.
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