Dance for Fun Registration

All the information you give is confidential and will not be disclosed beyond relevant committee members without your permission. Your information is stored on the King's Baptist Church Database system which is only accessible by our Administrative staff for the purpose of running this class.

Details

First Name *

Last Name *

Mobile Number *

Email Address *

Date of Birth *

Health Concerns

Tip: Are there any conditions which CareLink Ministries should be aware of regarding your health and well being eg. Asthma. allergies (food, drugs/medicine), convulsive seizures, diabetic, high / low blood pressure

Emergency Contact Details

Name *

Relationship

Phone Number *

I Agree

Please indicate your permission for the following.

By registering to attend any Dance classes you agreed to the Release of Liability Agreement:

1. I am participating in classes, offered by Carelink Ministries Inc. I recognise that dance classes requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks involved.
2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Classes. I represent and warrant that I am physically fit and I have no medical condition that would prevent my participation in the Classes.
3. I understand that it is my responsibility to advise the instructor of any injuries or health concerns.
4. In consideration of being permitted to participate in Classes, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the lessons.
5. In further consideration of being permitted to participate in Classes, I knowingly, voluntarily and expressly waive any claim I may have against Carelink Ministries Inc or the instructors for damages, and injury that I may sustain as a result of participating in classes.

I agree to these terms *

Yes