Belly Dance Class Registration Form

Belly Dance Class Registration

Belly Dance Registration Form

Date:

Your name:

Address:

Phone Number:

Email:

Class Name,
Date & Time:

Any medical condition or
injuries? If so, please
explain.

Method of Payment:
(tick one)

Cheque

Cash

I accept full responsibility for any personal injuries incurred
as a result of my participation in the Belly Dance classes
offered by Annyse Rayne.

I hereby release Annyse Rayne from any liability now or in
the future for any health conditions
that I may obtain in class.

I hereby affirm that I have read, fully understand
and agree with the above statements

I agree (check the box)