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
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?
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.
Media Consent
I give permission for photos or videos taken during classes to be used for promotional purposes (website, social media, flyers).
Signature
Participant Signature
Date

DayMonthYear
Parent/Guardian Signature
Date

DayMonthYear
Thank you for joining the dance class ✨
Select your class
prevnext( X )
Kids Ballet 4-5

$130.00 NZD Select class option



Kids Street Jazz 6-8
$130.00 NZD Select class option



Stretch & Strengthening
$100.00 NZD Select class option



Afro Latin Fusion Adults
$200.00 NZD Select class option



Modern Dance (Intermediate/Advanced)
$250.00 NZD Select class option



Private Class
1 hour

$85.00 NZD



Wedding/Event Dance
1 hour

$120.00 NZD Select class option



Total

$0.00 NZD
Should be Empty:

Dance Class Registration

Participant Information

Emergency Contact

Health & Wellbeing

Consent & Liability Waiver

Media Consent

Signature

Select your class