Belly Dance Sign UP Form
| Please complete form, print it out, and mail it with your check, money order ( Made to Cynthia Schankin): Bellydance Classes/Series, 3626 thomas Ave. Berkley MI 48072 | ||||
| Payment info: *Enclosed is: Check Money Order | ||||
| Student Name Last Name | ||||
Street City State Zip Code Phone | ||||
| E-mail | ||||
| Any Special Conditions | ||||
| Emergence Contact Phone | ||||
| Bellydance Class | Quantity | Description | Price | Amount |
| Summer Clinic 2010 | 6/20,7/18, 8/22 12:30-2:30p | $80 | ||
| #1 Zaget Clininc (Triplets) | June 20, 12:30-2:30p | $30 | ||
| #2 Zaget Clinic (Baladi) | July 18, 12:30-2:30p | $30 | ||
| # 3 Zaget Clinic (Modern Flare) | August 22, 12:30-2:30p | $30 | ||
| Total | ||||
Liability Waiver Agreement:* All Students and the parents/guardian are aware of possible injury that may occur during dance/fitness classes, performance, and/or rehearsals and are willing to assume those risks. It is agreed that the students and their parents/legal guardian will not hold Cynthia Schankin its directors, renters, officers, and/or its employees liable for injuries sustained while in attendance or while participating in any Dance/fitness related activity. We give permission to use pictures and/or videos of us and/or our child or children for advertising purposes. | ||||