Bollycise Student Registration Form

Course Registration Form

Introduction to Bollywood Dance
Thank you for your interest in our 8 week Bollywood Dance Class.

Please complete this registration form before attending your first class with us to confirm your spot. If you will be attending with a friend, they need to complete their own form.

CLASS will be held on Sundays at 5pm, for 8 weeks, commencing on 6 October.

Each class will run for approx. 60mins and will be held at the Riverside High School Gym Hall, just off the West Tamar Highway.

Payment can be made at the first class either by cash or card. ($80 for 1 person, or $120 for 2 people). We require a minimum of 6 students to procced with the class.

Please wear comfortable clothing (similar to what you might wear to the gym), and bring water as sometimes the hall can get a bit warm.
Name*

First NameLast Name
Mobile Number*
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Emergency Contact: *
Emergency Name
Mobile*
Emergency Phone.

Self Assessment Information
Have you done any dance or fitness classes before?

YesNo
Please specify what classes you have previously done?
Please advise of any medical conditions or allergies?
If you haven't exercised in a while, we recommend talking to your doctor.
How do you rate yourself in terms of fitness?

1

2

3

4

5

1 is Worst, 5 is Best

Disclaimer
Should be Empty: