Shimmy with Saniyah Belly Dance Workout Class Registration
This form is to gather a little information so that we can stay in touch. Your information will not be shared or sold and will only be used to communicate class and event related information via newsletter, email or text message.

Thank you for your interest and we look forward to seeing you in class.
Please provide your first and last name *
Your answer
Please provide your cell phone number *
We won't bug you. This is just in case we need to text or call.
Your answer
Please provide your email. *
Your information will remain private and will only be used for class related messages.
Your answer
Who should we contact in case of an emergency? *
Please provide their name, relationship to you and their phone number
Your answer
Did someone refer you? Please provide their name.
If you have their email, that would be better.
Your answer
Please feel free to provide your Instagram, Facebook and/or Twitter information to get connected on social media.
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy