Adults Salsa On2 Dance Classes!

Adults Class Registration Form

Today's Date

Participant's Full Name

Contact Number / Preferrably: Your Mobile #

Email Address

Address - Include: Street Address, City, State & Zip

Type of Class Attending

Salsa Level 1: Partner Work & Floor Shines Class

Salsa Level 2: Open Floor Shines

Salsa Level 2: Partner Work & Floor Shines Class

Salsa Level 3: Open Floor Shines

Free Text

Emergency Contact

Should there ever be a need, please provide us with someone to call in an emergency.

Emergency Contact #1 - Name & Best Number

Optional: Emergency Contact #2 - Name & Best Number

Free Text

Liability Waiver and Release

LIABILITY WAIVER AND RELEASE: I attest, as a student, that I am physically fit to partake in Addie Diaz’s dance class. I acknowledge that I am dancing at my own risk and by signing this waiver; I release Ms. Diaz & Addie-tude Cultural Arts Center from all claims on account of any injury, which may be sustained during dance class. I further agree to allow the use of photographs and video images in which the participant may be seen without payment for publicity purposes related to dance classes and activities. I agree that all such images are the sole property of Addie Diaz. I recognize that I am responsible for my personal possessions and will not hold Addie Diaz, or Addie-tude Performing Arts Center responsible for any damage or theft. *

I've read the above Studio Policies and AGREE.

I've read all of the above Studio Policies and DO NOT Agree.

REFUND PERIOD: If you cannot complete the course, you can receive a refund, minus any previous class taken. BUT you MUST ask for a refund no later than the second class (2nd wk) of that class card period.

I've read all of the above Studio Policies and AGREE.

I've read all of the above Studio Policies and DO NOT Agree.

Adults Class Registration Form

CORTLANDT MANOR

At: Parkside Corner Plaza

MOHEGAN LAKE

At: Argyros Plaza

PLEASANTVILLE

Home Studio
Downstairs: Ground Level

Adults Class Registration Form

CORTLANDT MANOR

At: Parkside Corner Plaza

MOHEGAN LAKE

At: Argyros Plaza

PLEASANTVILLE

*Home Studio*Downstairs: Ground Level

Home Studio
Downstairs: Ground Level