Registration Information
Full Name
Phone
Address
City
Province British Columbia Alberta Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
Postal Code
Birthday [Y-M-D]
Email
Date of Class/Workshop
Location of Class/Workshop
Please list previous hip hop dance experience
Please send my confirmation by Mail Email
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Additional Information
Emergency contact name(s) and relation:
Emergency contact number(s):
Do you have any medical conditions/allergies we should know about?
Liability Waiver
I, the undersigned, being 18 years or older, on behalf of the student named above, understand that CORE Revelation Productions and the instructors thereof are not liable for personal injuries, loss of or damage to, personal property. I understand that participating in dance classes involves the possibility of physical injury. I therefore assume all risks involved in the participation of Coreify Workshops presented by CORE Revelation Productions, whether it be I, or my participating minor child. I exempt, release and indemnify CORE Revelation Productions and the faculty thereof, including assistants, volunteers and administrative assistants from any and all liability claims, demands or causes of action whatsoever from any damage, loss or physical injury to myself or my participating minor child. I understand that each student may decline to participate in any activity.
By choosing "Yes, I Agree" below, I am acknowledging that I have read and agree to be bound by all the rules and regulations as stated on this registration form.
Yes, I Agree
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