Registration & Waiver Form

Persian Dance (Online)

2022

January & February

Age	Level	Date	Time	Location/Price
15+	All	Saturday (Jan 7- Feb 25)	2:30 pm -3:30 pm (Eastern Standard Time, Time zone in Toronto, ON (GMT-5)	Zoom/8 Sessions/ $80
15+	All	Saturday (Jan 7- Feb 25)	3:30 pm -4:30 pm (Eastern Standard Time, Time zone in Toronto, ON (GMT-5)	Zoom/8 Sessions/ $80

Name(required)

Email(required)

Phone Number

Date of Birth(required)

Address(required)

Choose one Class(required)

2:30 pm -3:30 pm (Eastern Standard Time, Time zone in Toronto, ON (GMT-5) 3:30 pm -4:30 pm (Eastern Standard Time, Time zone in Toronto, ON (GMT-5)

Emergency contact's full name(required)

Emergency contact's phone number(required)

Have you practiced Dance before?(required)

Yes No

If yes, for how long? and What kind of Dance?

Limitations/Injuries(required)

Do you have numbness/pain in any areas of your body? If yes, where?(required)

If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. It is important in Dance that you listen to your body and respect its limits on any given day.

I, the undersigned, understand that Dance is not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including dance. I recognize that it is my responsibility to notify my teacher of any serious illness or injury before every dance class. I will not perform any postures to the extent of strain or pain. I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to a person or property, resulting from the taking of the class. Those under 18 years of age must have this form signed by a parent or guardian. Please print your full name and date below.(required)

Payment

All tuition is to be paid on the first week of each term. A 10% penalty will be applied to outstanding fees.

Once payment is processed, there will be no refund.

(required)

I agree with all terms and conditions.*

Persian Dance (Online)

2022

January & February

Once payment is processed, there will be no refund.

Share this:

Like this: