Momo Movement 2019 Summer Fun Registration Form
Adult classes are for participants 18 years and older.

Classes take place at:
Inside Out Theatre
Eau Claire Market, 200 Barclay Parade SW

Summer fun class dates and time:
July 8, 9, 10, 11 and 12
1:00 PM to 2:30PM daily

$50.00 for the week

Basic information
Are you new to Momo or a returning dancer? *
Dancer information
Dancer's first name *
Your answer
Dancer's last name *
Your answer
Contact phone number *
Your answer
Contact email address (where should we email registration and class information?)
Your answer
Emergency contact information
First name *
Your answer
Last name *
Your answer
Phone number *
Your answer
Email address *
Your answer
Relationship to dancer
Your answer
Support organization information
This section is optional
Organization name
Your answer
Contact person
Your answer
Phone #
Your answer
Email address
Your answer
Payment information
Full payment is due 3 weeks before classes begin, a reminder email will be sent out.

Payments can be made by cheque, Paypal or e-mail money transfer.

Cash payments can be made in class on the first day, if arrangements are made in advance. Contact to make arrangements.

Cheques should be made payable to MoMo Mixed Ability Dance Theatre.

Paypal and e-mail transfer address: Please make "dance" the answer to the security question.

Please reference the participant's name, and class date and time on all payments.

Payment method *
Liability waiver
I, as named above, hereby release MoMo Mixed Ability Dance Theatre from any claims, demands and causes of action as a result of my participation or enrolment in the program; participate in all MoMo activities at my own risk; assume all risk involved, including but not limited to all lost or stolen property, cost, claim, injury, damage or liability sustained while participating. *
Photo and video release consent
I, as named above, give permission to MoMo Dance Theatre and media representatives invited by MoMo Dance Theatre, to take photographic and video images of me while I am participating in MoMo Dance Theatre facilitated classes, workshops and performances.I recognize that these images could be used in several ways, including but not limited to: 1. Promote MoMo Dance Theatre 2. Educate people about MoMo Dance Theatre 3. Demonstrate what MoMo Dance Theatre does and is about 4. Include in the portfolio of the photographer/videographer who captured the imagesI retain the right to rescind the permission granted by signing this form at any time. *
Thank you for registering for Momo classes!
Once you hit the submit button at the bottom of the page, your registration form will be complete.

Confirmation and payment emails are sent out once a week on Thursdays.

If your chosen class is full, you will get the next spot on the waiting list and we will let you know!

If you have questions, please contact

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