Registration and Waiver of Liability Form
Bellydance by Zahira

Name: __________________________________________

Address: ________________________________________

City: ___________________________________________

State & Zip: _____________________________________

Telephone: ______________________________________

E-Mail: _________________________@______________

Waiver of Liability
You are participating in this class at your own risk. Movements, stretches, dancing, etc., derived from this learning experience, including working on such outside of class, are at your own risk. As always, seek the advice of a medical expert before participating in this particular activity, at home, in class, or otherwise, to ensure your own safety and health.

Please note that if a lawsuit is filed, and the ruling is against you, you will be liable for any and all legal costs involved in such suit. This waiver applies to any and all bellydance classes, workshops, seminars, and public venues sponsored by Nancy E. Frye, aka Zahira.

By signing this Waiver, you hereby acknowledge that your participation is at your own risk, and that you assume all responsibilities for any and all aspects of participation.

____________________________________
Signature acknowledging Waiver of Liability
and acceptance of such.

________________________
Date of Signature

Personal Notes

First-time student for Bellydance?...........Yes......... No

How did you hear about this dance class?

What picqued your interest in bellydancing?