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Fusion Bellydance Class
Registration for bellydance classes offered by Erika Miller/Tranquilessence Bellydance
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Preferred Name & pronoun *
Phone Number *
Email *
Can I add you to my email list? *
Emergency Contact (Name & Number) *
What is it that excites you about this class?! (i.e. fitness, refining dance technique, curiosity/want to try something new, love to dance, community, feed my creative side, etc.) *
Do you have any injuries that the instructor should be aware of (past or present)?  If so, please briefly describe.  (If you have any current injuries, confirm with your doctor that you are cleared to participate.) *
What would you consider your level of dance experience to be? *
Do you plan on primarily attending in person or via Zoom?   *
If you answered "Zoom" above, what's the best way for me to send you the link?
As a participant of class, recognize that there are certain risks of physical injury.  By typing your name below, you agree to assume full risk of injuries that you may sustain as a result of participating in any activities connected with the classes offered.  You also release and hold harmless the instructor-Erika Miller, Tranquilessence Bellydance, The Green Earth-and it's owners, from liability for any injury, damage, or loss which occurs before, during, or after classes.  (PLEASE ENTER FULL LEGAL NAME BELOW) *
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