* Required Fields

*Name:

*Address:

*City:

*Province:

*Postal Code:

Day Phone:

*Evening Phone:

*Email:

I would describe
myself as a:

Someone who is new to dance
I have done some dance training but it is some time ago
I have done some recent dance training
I'm a dancer                

Do you have any physical
or health condition that
we should be aware of?

Please read the following: Your registration confirms that you are aware that participation in movement workshops and other physical activities involves a risk of normal injuries associated with that participation. Your involvement in this workshop demonstrates of your acceptance of such risks and your understanding that the Victoria Dance Series Society, Lynda Raino Dance, Barbara Bourget and Kokoro Dance accept no responsibility for such normal activity related risks.

I agree.