Fall St. Louis Shag Workshop
Please complete the information below to register for the Fall St. Louis Shag Workshop hosted in Minneapolis, MN on October 14, 2017. Payment must be made separately.

Progressive Classes 12-4:45 pm
Add-On ain’t./Adv. Class 5-6 pm
Evening Social Dance 8-10 p

First Name *
Your answer
Last Name *
Your answer
Dance Role *
How did you hear about this workshop? *
Email Address *
Your answer
Phone Number *
Your answer
Street Address / Apt # *
Your answer
City / State / Zip Code *
Your answer
What are you registering for? *
If you signed up for classes a la carte, which ones do you plan to attend? **St. Louis Shag Essentials is required if you have never learned St. Louis Shag from us before.** (Check all that apply)
Waiver & Liability Release
By registering for, attending, and/or participating in the Fall St. Louis Shag Workshop classes and social dance party hosted by MN St. Louis Shag and its organizers (Katie Leatherberry & Gary Grimm), you hereby agree to the following:

You recognize that dancing requires physical exertion that may be strenuous and may cause physical injury, and you are fully aware of the risks and hazards involved. Additionally, you represent and warrant that you are physically fit and have no medical condition that would prevent your full participation in the dance classes and/or social dance party. You agree to assume full responsibility for any risks, injuries or damages, known or unknown, which you might incur as a result of attending and/or participating.

You authorize MN St. Louis Shag to use any photo or video in which you may appear, for promotional purposes and video distribution, and waive any rights of compensation or ownership.

In consideration of being permitted to attend and/or participate in the dance classes and social dance party, you knowingly, voluntarily and expressly waive any claims you may have against MN St. Louis Shag its instructors, organizers, volunteers, and independent contractors, for injury or damages that you may sustain, or anything else, as a result of attending and/or participating.

You acknowledge that MN St. Louis Shag its instructors, organizers, volunteers, and independent contractors cannot be held responsible for any loss or theft of your belongings and/or property, at all locations, and that you are solely responsible for them.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. *
Payment Options
Payment for this event should be made no later than 10 pm on Saturday, October 14th or an additional late fee of $10 will be added to the total cost. Payments can be made via Paypal or check either hand-delivered or mailed.

Paypal - Please submit payment to katie.leatherberry@gmail.com

Check - Please write checks out to Katie Leatherberry and mail payments in c/o K. Leatherberry to: 815 N. McCarrons Blvd #101, Roseville, MN 55113

How will you submit payment? *
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