Bellydance with Jeylan Registration 2020
Please complete the following to register for bellydance classes with Jeylan at Two Left Feet Dance Studio in Newport News, VA. (If you previously completed this form, there is no need to repeat it; please just send an email or text with your intention. Thanks!) For questions or more information, please email
, call 757-912-5591, or go to
First and Last Name
Preferred Phone Number (in case of class changes)
May Preferred Phone receive texts?
I am registering for the following class/es. (Minimum number of students required for class to happen.)
Sundays at 6 pm (evenings)
Thursdays at 11 am (mornings)
Riverside Appreciation Night, Sunday, 2/2/20 (Free to Riverside Elementary Staff)
Dance Experience (types, amount of time)
Why are you interested in taking this class? What would you like to accomplish?
How did you hear about Jeylan's classes?
By completing my name below and submitting this form I agree to abide by the pay schedule and will inform the instructor of any absences as soon as possible. I will not hold Jeylan, Rachel Bevins, or Two Left Feet Dance Studio liable for any injuries occurring to me during classes or related times. (Type name)
Classes cost $15 each or $10 per week for a total of $60 for a package session due at the start of class or session. Paypal is preferred; please send to
. Checks and labelled cash also accepted at the first class. Riverside Elementary Teachers and Staff get one free class on February 2, 2020.
Send me a copy of my responses.
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