Dance Class Registration
Participant Information
Name
*
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*
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Age (if under 18)
Email
*
Phone Number
*
Address
*
Street Address
Street Address Line 2
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Select your class
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( X )
Kids Modern Dance
$
84.00
NZD
Select class option
Term
Casual Class
Afro-Latino Adults
$
140.00
NZD
Select class option
Term
Casual Class
Modern Dance (Beginner/Intermediate)
$
161.00
NZD
Select class option
Term
Casual Class
Modern Dance (Intermediate/Advanced)
$
175.00
NZD
Select class option
Term
Casual Class
Stretching-Strengthening
$
140.00
NZD
Select class option
Term
Casual Class
Private Class
1 hour
$
85.00
NZD
Wedding/Event Dance
1 hour
$
120.00
NZD
Select class option
Casual Class
Pack of 5 classes
Pack of 8 classes
Emergency Contact
Name
First Name
Last Name
Relationship
Phone Number
Health & Wellbeing
Do you have any injuries, medical conditions, or physical limitations the instructor should be aware of?
*
No
Yes
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).
*
Yes
No
Signature
Participant Signature
Date
-
Day
-
Month
Year
Parent/Guardian Signature
Date
-
Day
-
Month
Year
Thank you for joining the dance class ✨
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