Delightful Dance

REGISTRATION FORM

PLEASE PRINT CLEARLY

ONE FORM PER PERSON please

Print out and fill in. Bring to class or mail in. Thanks, Miss Lori

 

NAME

First______________________Last_________________________________

HOME PHONE

________________________ WK PHONE_____________________________

E-MAIL

________________________ Cellular Phone__________________________

ADDRESS

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

CLASS NAME

_____________________________________________________________

DATE AND TIME

_____________________________________________________________

Birthdate

_____________________________________________________________

Height

_____________________________________________________________

Referred by

_____________________________________________________________

PARTNER'S NAME

_____________________________________________________________

Signature

_______________________________________________________________________

Sorry no refunds.   $25.00 NSF fee.

 

Warning/Release: You are advised to consult your physician before beginning this or any other dance program or activity. The author, producers, performers, instructors and/or distributors disclaim any liability for losses or injuries sustained in connection with any advice, activity or demonstration contained herein or at any event, party, dance, workshop, class, or demonstration.

 

By submitting my registration I acknowledge that I have read and accept the above warning/release.