Dance Class Registration and Indemnity Form

Hi, thanks for reaching out! I'd love to dance with you.

Epic Motion is a space to move, to breathe, and to feel. For me, dance is freedom — a way to grow confidence, explore creativity, and make a connection, with either yourself or a fellow dancer.

Join our adult lyrical & contemporary classes (18+).
AM Tuesdays 11:15-12:15

PM Thursday 8:15-9:15pm

All levels welcome.

From April 21st we will begin offering the follow classes. Book now to secure your spot.

Tuesday PM

Beginners 18+ 19:15-20:00

Tuesday Classes for KIDS

Mini Movers 14:15-15:00

Juniors 15:00-15:45

Jinour Higher 15:45-16:30

No matter how long it’s been, or if it's your first class, come awaken your body and discover your love for dance.

Trial class just £10 — click the link below for more info!

Yours in dance,
Rachel

https://www.instagram.com/epicmotion_ni/
Enrolment and Consent 2025/26

Please read, complete and sign. Once you have submitted your registration, you are enrolled for your selected classes and will receive an invoice shortly. You will also be added to any admin groups/broadcasts.
EpicMotion_NI

1 Dufferin Avenue, Dufferin Square, Bangor, BT20 3BX Sinéad Roberts 07917276136 rachelroberts0105@gmail.com
Dancer

Please include full name.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number

Area CodePhone Number
Date of Birth

DayMonthYear
Date
Emergency Contact

First NameLast Name
Emergency contact Phone Number

Area CodePhone Number
Residential Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Health and medical disclosure
Please list any medical conditions, injures, allergies or medicationa we shuld be aware of. (e.g. asthma, joint issues, epilepsy,ect.)
I confirm that I am physically able to participate in dance and movement classes. I understand it is my responsibility to consult a medical professional before participating if I have any concerns. Initials:
Liability Waiver and Insurance Consent I acknowledge that participation in dance classes carries a risk of personal injury. I understand that epicmotion_NI takes all reasonable precautions to ensure safety, but cannot accept responsibility for injuries sustained during classes, rehearsals, performances. I voluntarily assume all risks related to participation and agree that epicmotion_NI, its instructors, and affiliates shall not be held liable for any injury, accident, or loss of personal property. Initials:
GDPR & Data Protection In accordance with the UK General Data Protection Regulation (UK GDPR), I consent to epicmotion_NI securely storing and using my personal data for class registration, communication, emergency contact, and marketing purposes (if opted in).
Your data will never be shared with third parties without your consent. You can request to view, update, or delete your information at any time. Initials:
Code of Conduct and Respectful Communication At epicmotion_NI we are committed to creating a welcoming and inclusive environment for all participants and staff. We ask that everyone communicates with kindness, respect, and professionalism at all times — both in and out of class. Bullying, harassment, discrimination, or any behavior that violates another person’s privacy or dignity will not be tolerated. This applies to all interactions between dancers, teachers, and any studio affiliates. Any concerns or incidents can be reported confidentially to Sinead Roberts, manager of epicmotion_NI, and will be handled with sensitivity and seriousness. By signing this form, you agree to uphold this standard and contribute to a safe and supportive studio community. Initials:
Payment Methods· Payments to be made in cash or EFT. If in cash, please place in sealed envelope with name, amount and date in clear block letters. Banking Details for EFT· Sinéad Roberts HSBC 40-19-16 Acc Number: 61526847 Ref: Initials and surname with Class Option·

Please email proof of payment to: rachelroberts0105@gmail.com and copy down the details above now as you cannot view them after the completed form has been submitted.
Fee Options
· I undertake to pay tuition fees as stipulated, within the first week of each option or, before each lesson; in advance; monthly/termly as agreed. · I acknowledge that there will be no credit or refund of fees should I/the student miss any lessons. I accept liability of two weeks' notice should I/the student wish to terminate/s lessons. · I hereby acknowledge and agree to the terms of payment. Initials
Photography & Video Consent grant permission for epicmotion_NI to photograph and/or video me during classes, rehearsals, or performances. These may be used for: Social media promotion Website and marketing materials Educational and training purposes
Declaration I confirm that I have read and understood the information above. I agree to abide by the studio's rules and safety guidelines and understand that my participation is at my own risk. Signature to Acknowledge Indemnity Agreement
Name (print) and Date
Should be Empty:

Enrolment and Consent 2025/26

EpicMotion_NI

Dancer

Payment Methods· Payments to be made in cash or EFT. If in cash, please place in sealed envelope with name, amount and date in clear block letters. Banking Details for EFT· Sinéad Roberts HSBC 40-19-16 Acc Number: 61526847 Ref: Initials and surname with Class Option·