DAncefx Athens Drop In Form

Please use this form ONLY for *Drop-In classes, pUnchcards, workshops, summer camps, and room rentals**. If you would like to register for a weekly class or classes, please use* this form. Thank you!

DROP-IN RATES

Trial Drop-In (one per client) $8

Drop-In Class $20

4-Class Punch Card $78

10-Class Punch Card $195

Salsa & Bachata Drop-In $10

4-Class Salsa Punch Card $35

10-Class Salsa Punch Card $85

Punch cards are valid for 3 months following purchase date.

Dancer's Name

First Name

Last Name

Gender

Dancer's Birthdate

YYYY

Parent's Name (if under 18)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone Number

(###)

###

####

How did you hear about Dancefx?

Credit Card Information

In order to reserve a drop-in spot in a class, we require payment at the time to reservation to guarantee availability. Availability will be confirmed with an email and payment receipt. We will not charge the card submitted unless space is available in your chosen class. Please indicate your credit card number, expiration date, security code, and billing zip code if you would like to use a card as your method of payment.

Would you like us to save this card information on file to be used in the future? If you select "no" the information will be disposed immediately following the initial charge. Card information kept on file is encrypted as soon as it is saved on the dancer's account.

Yes please

No thank you

Which class(es) are you interested in for Drop-in classes? Please include the date, time, and class description.

Please use the space below for any notes or questions.

Please read the following liability waiver below and write your full name and today's date below to indicate that you have read and agree to the following.

The undersigned hereby acknowledges that participation in dance programs and outreach activities involves an inherent risk of physical injury and hereby assumes all such risks. Dancefx assumes no responsibility under any circumstances or at any time for personal property of the undersigned. The undersigned hereby agrees that for the sole consideration of Dancefx allowing the undersigned to participate and making available to the undersigned for his/her use while participating in such programs, activities or personnel, the undersigned participant does hereby waive liability, release and forever discharge Dancefx, its board members, instructors and employees from any and all demands, rights and causes of action of whatever kind or nature, arising out of all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to or loss of property, and the consequences thereof, including death, resulting from my participation in or in anyway connected with such dance programs or outreach activities located on the premises or offsite. I acknowledge that it is my responsibility to seek the advice of a medical professional if I have questions about my (my child’s) physical ability to participate in any dance activity. I further covenant and agree that for the sole consideration stated above I will not sue Dancefx, its members, instructors, or employees for any claim for damages arising or growing out of my (my child’s) participation in the dance programs or outreach activities. This Release, Waiver of Liability and Covenant Not to Sue shall remain in effect for as long as I (my child) am (is) a participant in programming at Dancefx. I certify that I (my child) am (is) suffering under no legal disabilities and that I have read the above carefully before signing.

Thank you for reserving a drop-in with us! We will follow up shortly with confirmation and receipt of payment. We can't wait for you to join us!

Ok : )

DAncefx Athens Drop In Form

Please use this form ONLY for Drop-In classes, pUnchcards, workshops, summer camps, and room rentals. If you would like to register for a weekly class or classes, please use this form. Thank you!

DROP-IN RATES

Please use this form ONLY for *Drop-In classes, pUnchcards, workshops, summer camps, and room rentals**. If you would like to register for a weekly class or classes, please use* this form. Thank you!