BODYWORKS BY CHANDANI

REGISTRATION AND LEGAL RELEASE FORM

~ To register for class, send your payment and this signed registration form to Bekah James, BodyWorks By Chandani, 178 Thalia Village Shoppes Suite C Virginia Beach, VA 23452. Payment for Beginner 1 classes is $98. Beginner 2 classes are $88. Each level after that is $83. Tribal Belly Dance is $73. Please make checks out to Bekah James. Be sure to send it plenty early in order to reserve your spot. If you are under 18 you must have your registration form signed by a parent or guardian.

~ There are no refunds. Please do not sign up for a class if you are unsure of your ability to attend class. All classes, workshops and services must be paid for in advance and are not transferable or refundable. I understand that certain class packages purchases involve certain expiration dates that have been explained to me in full. I understand that I am registered for a certain set of dates and that if I miss a class there is no make-up class, unless I pay for additional private lessons.

~ Credit is given only incase of severe illness or injury. To receive credit you should notify me no less than one week after your illness or injury and then send me a doctors note no less than two weeks after your illness or injury. The note must be a signed legitimate doctors note which includes the date of your visit and expected recovery. It must state that you are unable to participate in an activity such as dancing until your recovery date. Once this is completed you will receive your letter of credit which must be used consistently starting no less than one week after your recovery date.

~ Cancellations happen on rare occasions such as lack of enrollment or the instructors illness. In such cases you will be notified as soon as possible by email or phone or text. If you have paid for the cancelled class you will be refunded or you can chose to apply your refund to an upcoming class or workshop.

 ~ I understand that all returned checks will be fined a $40 fee. I understand that any merchandise that I damage is my responsibility and I will pay for the item(s) in full.

      By my signature, I do hereby stipulate that I am in physically, mentally, spiritually sound and healthy condition, and able to perform the activities/exercises conducted during any and all classes, training, workshops, private instruction and any other yoga, dance, massage, movement activity offered at BodyWorks By Chandani. I understand yoga, dance and other exercise classes involve a high level of physical activity and exertion and as with any form of exercise involve certain risks of injury, falls, muscle soreness, cardiovascular stress and accidents. I stipulate and agree that any and all activities that I participate in BodyWorks By Chandani or with any BodyWorks By Chandani staff are done solely at my own risk.

I do hereby release and hold harmless today, or at any time in the past or future Bekah James, and any other staff member of BodyWorks By Chandani from any liability for injuries or damages to my persons or my property arising out of or connected with, the use of services offered by Bekah James, or any other BodyWorks By Chandani staff member. I do hereby and forever release by Bekah James, or any other BodyWorks By Chandani staff members from all such causes of action.

 

Start date and Name of class registering for: _________________________________________

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Name______________________________________________________________________________

Street Address_____________________________________________________________________

City, State and Zip Code____________________________________________________________

E-Mail address_____________________________________________________________________

Home Phone__________________________       Mobile: _________________________________

May your instructor text you? _____ Yes           _____ No

Are you under 18 years of age?______________ If yes, age: ____________________________

What is your reason or goal for dancing?____________________________________________
How did you hear about this class? Flyer, Website (please specify which website), friend, other?

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Do you have any physical conditions or problems we should know about? Such as pregnancy, asthma, or any thing else that should be taken into consideration before participating in dance?

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Dance Styles studied previously?____________________________________________________
 

DATE: __________________________

SIGNATURE OF PERSON ATTENDING CLASSES:

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If person is under 18, the parent or guardian must sign.