Course Registration Form

Name*

First NameMiddle InitialLast Name

Birth Date

MonthDayYear

E-mail*

example@example.com

Phone Number*

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By joining the list, you're giving permission for me (Tiera) to send you email and text updates about upcoming dance classes, fun challenges, and feel-good movement reminders. No spam - just good vibes only!

I, the undersigned, understand and agree to the following: I am voluntarily participating in dance fitness classes offered by Tiera Brown. I understand that dance fitness involves physical activity, which may include strenuous movement, balance, flexibility, and cardiovascular exercise. I acknowledge that participation carries risks of injury, including but not limited to: muscle strains, sprains, falls, and other physical injuries.I affirm that I am physically capable of participating in this class and that I have either:consulted with a physician before participating, OR chosen to participate at my own risk without medical advice. In consideration of being allowed to participate, I hereby release, waive, and discharge Tiera Brown, instructors, and affiliates from any and all claims, demands, or causes of action arising from any injury, loss, or damage that may occur during or as a result of participation in the dance fitness class.I agree to hold harmless and indemnify Tiera Brown from any liability resulting from my participation.Photography/Video: I consent to photos/videos being taken during class and used for promotional purposes.I have read this waiver and fully understand its terms. I am signing it freely and voluntarily, intending my submission to be a complete and unconditional release of liability.

Join the Dance Party!