Registration
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We welcome all adults (and teens) to our 6 Week Fitness Series that begins on Saturday, January 11th, 10am . We're offering Zumba, Mixxed Fit, Step, Line Dance, & more Come all 6 weeks for ONLY $50! You can't beat that price! This is a limited offer and is guaranteed to sell out! If you all show up and out, we'll continue and add more classes starting March Dates: January 18, 25 February 1, 8, 15, 22
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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Family Information
First Name:
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Last Name:
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Parent or Guardian
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Other
Parent
Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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Zip:
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Emergency Contact Info
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Additional Information:
Media & Liability
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I authorize Eagles Landing Dance Center to use pictures of myself in its
promotional materials, social media sites, including on its website. I certify
that I'm in proper physical condition to take part in all dance and fitness
activities. I realize that there are possible risks involved in fitness/dance. I agree to
assume the risk of all injuries or damages that may arise from my
participation in the fitness/dance activities of Eagles Landing Dance Center. In
consideration of the above, I hereby release and hold harmless Eagles Landing
Dance Center, its agents, and employees & contractors from and against any
liability or claim for any loss of property, injury, misadventure, harm, cost, or
damage sustained as a result of my participation in Eagles Landing
Dance Center’s classes and activities.
I've read the above and agree.
Enter your Full Name:
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