Jazida Dance Classes - Student Information Form
Real Name *
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Stage Name (if applicable)
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Mobile Number *
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Email Address
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Emergency Contact Name *
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Emergency Contact Phone *
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Medical Alerts *
Please indicate or describe any medical conditions which we should be aware of. If you have asthma, allergies or any other condition that requires an action plan, please inform Jazida before you commence class.
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Do you accept the terms and conditions? *
Full terms and conditions are available at: www.jazidaburlesque.com/class
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