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Medical and registration form
ALL INFORMATION WILL BE KEPT CONFIDENTIAL
Full Name
Address
How Did You Hear About The Class?
Email
Contact Telephone Number
In Case of Emergency, Please Provide a Name and Contact Number
Are there any medical issues which may affect your participation in a dance class that we need to be aware of? Or should something happen to you, is there anything that might be useful information when seeking emergency medical care?
I confirm that I have completed the above questionnaire to the best of my ability and that I have provided accurate information regarding my current health status. I take it upon myself to discuss any changes in my health with the teacher and my Doctor. I understand that any dance/exercise class has certain risks. I understand that the degrees of risk depend on my health and physical fitness. I am voluntarily participating in classes with Sonia Brown, and will immediately discontinue any activity if I feel any symptoms of distress or discomfort, and will notify the tutor.
I confirm that I have read, understand and agree to the privacy agreement.
View privacy agreement
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