Bellydance with Z=
aina
**For Zaina and studio use only – will not be
shared**
Date: _________________________________________=
____________________
Name:_____________________________________________________=
________
Address:_____________________________________________________=
______
City&Zip=
:_____________________________________________________=
______
Phone Home
E-Mail:
____________________________________________________________
Dance backgr=
ound:__________________________________________________
&=
nbsp;
Where did yo=
u hear
about class?
A friend: __=
________________________________________________________
Newsletter (=
which
one?):____________________________________________
Rock Your Bo=
dy
Studio:_________________________________________=
_____
Internet Sou= rce:____________________________________________________<= o:p>
(Which one?
Bellydancewithzaina.com, Active Culture, etc…)
Other:_____________________________________________________=
_______
$50 per session to be paid in cash on first night of class or $12
Drop-in Rate
WAIVER
Use of the facilities a=
nd
participation in dance or other physically demanding activities inherently
exposes the participant to certain degree of risk of personal injury, illne=
ss,
and other adverse medical consequences.&nb=
sp;
The facility/individual instructor is not an insurer of a member's l=
ife
or personal safety. No indivi=
dual
will engage in activities that, which require a level of physical fitness
exceeding his/her physical condition or abilities, as determined by the ind=
ividual. Every person assumes the risk of
personal injury, illness, or other conditions arising out of or related to =
the individual's
activities on facility premises and releases the facility/individual instru=
ctor,
its directors, officers, agents, and employees from all claims, actions, or
liability on account of such causes.
Initial________