Intermediate Bellydance with Accalia Registration Form
LEARN MORE ABOUT THIS CLASS HERE: https://www.facebook.com/events/232478913949437/

RECOMMENDED FOR DANCERS WITH 2+ YEARS OF BELLYDANCE STUDY
Event Timing: January 21st - May 6th, 2018 / Sundays at 6pm
Event Address: 109 Pulford Street, Winnipeg, MB
Contact us at info@deeproots-strongdance.com

Name *
Your answer
Email *
Your answer
Emergency contact person - name *
Your answer
Emergency contact - phone number *
Your answer
Dance Background *
I understand the following; My spot in this class is reserved only upon the completion of registration. Registration is complete only upon the submission of this form AND the payment of $50 by eTransfer. *
Required
I understand the following; Should there be openings in the class when it begins on Jan. 21, students may, instead of eTransfer, pay their $50 registration fee in person (cash or cheque to Deep Roots - Strong Dance). However, there is no guarantee that there will be openings in class at this time. Registration for the class is first come, first served. *
Required
What do you hope to learn and / or achieve during the Intermediate Class? (optional)
Your answer
I am 18 years of age or older *
If participant is under 18 years of age, this online registration form will not apply. Underage participants will have to register in person, with permission of a parent or guardian. Email info@deeproot-strongdance.com for more information.
Required
WAIVER
Participant risk acknowledgement, release, waiver of claim and assumption of risk for Bellydance Classes with Accalia and use of the dance class facilities.
I agree and acknowledge that:
1. I am aware that there are risks and hazards inherent in learning a new style of dance. I am aware that I may participate only to the extent that I personally decide to, and therefore, I voluntarily and freely assume the risks of my participation in Bellydance Classes with Accalia.
2. I hereby release and forever discharge and hold harmless Accalia Robertson, the tenants of the dance class facility, the owners of the dance class facility, employees and volunteers (All hereinafter referred to as the "Releasees") of and from any and all claims, demands, damages, proceedings, expenses, actions, or causes of action in law or in equity in respect to any death, injury, loss, or damage to myself or to my property howsoever caused and arising or to arise by my use of the dance class facilities including, without limiting the generality of the foregoing, the negligence of the Releasees.
3. I agree to indemnify and save harmless the Releasees for any claim, including any claim for medical services arising from the use of the dance class facilities.
4. I am aware of the nature and effect of this Release, Waiver of Claim and Assumption of Risk, my voluntary signature on this Release, Waiver of Claim and Assumption of Risk is binding upon myself, my heirs, my executors, administrators and assigns.
5. This Release and Waiver of Claim shall be binding upon me, my heirs, executors, administrators and assigns.
6. I am executing this Release and Waiver of Claim and Assumption of Risk freely and voluntarily without any compulsion on behalf of Bellydance Classes with Accalia.
7. I acknowledge that I have read this entire Agreement prior to signing it. Intending to be legally bound I have signed this Release, Waiver of Claim, and Assumption of Risk.
I agree *
Additional Notes (optional)
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Deep Roots Strong Dance. Report Abuse - Terms of Service - Additional Terms