Dance Class Release Form
Please fill out this form to participate in our fitness classes. This form includes a release of liability. Cost is $5 per class.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name of guardian if participant is under the age of 18
*
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any medical conditions or injuries that we should be aware of?
Date: 3:30pm - 4:30pm
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Month
-
Day
Year
Date
By typing my name below I am acknowledging I have read and agree to the terms and conditions linked above.
Date
-
Month
-
Day
Year
Date
How would you like to pay?
Pay cash at class $5.00
Pay with card online $6.00
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Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Submit
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