JAMILA ZAHRAN DANCE REGISTRATION FORM (PRE-REGISTRATION
REQUIRED)
NAME
AGE
ADDRESS
WORK PHONE
HOME&/OR CELL PHONE
PLEASE INCLUDE * ON
NUMBER AT WHICH YOU CAN BEST BE REACHED IN CASE OF CLASS
CANCELLATION
E-MAIL
PREVIOUS DANCE EXPERIENCE
PLEASE MAKE ME AWARE OF ANY MEDICAL CONDITION OR
MEDICATIONS YOU ARE TAKING OF WHICH I SHOULD BE AWARE.
HOW
DID YOU FIND OUT ABOUT CLASSES/JAMILA ZAHRAN (INTERNET,FRIEND, NEWSPAPER
AD,
ETC.)?
I
WILL BE ATTENDING:
BEG. MED CLASS
CONT.
MED CLASS
SPANISH
DANCE CLASS
I WILL BE PAYING:
4
CLASS CARD
4 CLASS CARD
CASH
OR CHECK (PLEASE MAKE PAYABLE TO SANDRA HANES ) MUST BE PAID AT BEGINNING
OF CLASS SESSION. NO REFUNDS WILL BE
GIVEN.
THE UNDERSIGNED STUDENT AGREES THAT
SANDRA A. HANES (D/B/A/ JAMILA ZAHRAN)AND MISS CASEY'S DANCE ACADEMY ASSUME NO LIABILITY OR RESPONSIBILITY FOR INJURIES OR
OTHER DAMAGES OF ANY SORT SUSTAINED BY THE STUDENT WHILE THE STUDENT IS IN
ANY WAY PARTICIPATING IN THIS CLASS. SUCH INJURIES OR DAMAGES ARE THE
RESPONSIBILITY OF THE STUDENT, WHO ASSUMES SAID RESPONSIBILITY IN
PARTICIPATING. THE STUDENT AGREES TO HOLD THE ABOVE MENTIONED HARMLESS
REGARDING ANY DAMAGES, INJURIES, OR CLAIMS.
SIGNED
DATE
*
*
*WITNESS:
* PLEASE CHECK BUTTONS SO THAT THESE
WILL BE INCLUDED ON YOUR REGISTRATION FORM AND CAN BE COMPLETED AT FIRST
CLASS.
PLEASE REMEMBER TO CLICK SUBMIT BUTTON BELOW TO COMPLETE YOUR
REGISTRATION.
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