Modern Dance Technique
Registration

* Required Fields

*Name:

*Address:

*City:

*Province:

*Postal Code:

Day Phone:

*Evening Phone:

*Email:

I am currently dancing at (studio):

 

           

My dance instructor's name is:

I found out about this class from:

Allergies:

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.

 



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