Flow Dance Course Registration

Dance Class Registration
Participant Information
Name*

First NameLast Name
Birth Date*

DayMonthYear
Age (if under 18)
Email*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Select your class
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Kids Modern Dance
$84.00NZD Select class option



Afro-Latino Adults
$140.00NZD Select class option



Modern Dance (Beginner/Intermediate)
$161.00NZD Select class option



Modern Dance (Intermediate/Advanced)
$175.00NZD Select class option



Stretching-Strengthening
$140.00NZD Select class option



Private Class1 hour
$85.00NZD



Wedding/Event Dance1 hour
$120.00NZD Select class option



Total

$0.00NZD
Emergency Contact
Name

First NameLast Name
Relationship
Phone Number
Health & Wellbeing
Do you have any injuries, medical conditions, or physical limitations the instructor should be aware of?*

NoYes
If yes, please specify
Consent & Liability Waiver
I understand that participation in dance class involves physical activity and carries a risk of injury. I confirm that I am physically fit to participate and agree to take full responsibility for my health and wellbeing during classes.I release the instructor and studio from any liability for injury, loss, or damage sustained during participation, except in cases of proven negligence.*

I agree to the above terms
Media Consent
I give permission for photos or videos taken during classes to be used for promotional purposes (website, social media, flyers).*

YesNo
Signature
Participant Signature
Date

DayMonthYear
Parent/Guardian Signature
Date

DayMonthYear
Thank you for joining the dance class ✨
Should be Empty:

Dance Class Registration

Participant Information

Emergency Contact

Health & Wellbeing

Consent & Liability Waiver

Media Consent

Signature