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Please complete this form to register your place
Your details
Name:
I want to enroll on
Email:
Contact Number:
House Number:
Street/Road:
Town:
County:
Date of Birth:
Age:
Medical Information
Current health
I have a health condition - We will contact you about this
I have no known health conditions
How did you hear about us ?
Please select
Media
Google
Face Book
Word of Mouth
Advert / flyer
Other
Emergency Contact
Name
Contact Number:
Experience:
Name (click to edit)
I have no dance experience
I have some dance experience
I have a lot of dance experience but not in burlesque
I have burlesque dance experience
Medical Release and Waiver
Please Read:
THE FOLLOWING DESCRIBES THE TERMS ON WHICH SCHOOL OF BURLESQUE UK OFFERS YOU ACCESS TO OUR SERVICES. I wish to participate in a dance and/or fitness class at the studio. As a condition of School Of Burlesque U.K agreeing to allow me to participate in such a dance and/or fitness class, I hereby confirm and agree to the following: 1. I recognize that the dance and fitness classes of the type I intend to participate in at School Of Burlesque UK requires some physical exertion which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. 2. I understand that it is my responsibility to consult a physician/GP prior to and regarding my participation in any classes I attend at the studio. I represent that I am physically fit and have no medical condition that would prevent my full participation in any such fitness or dance class. 3. I agree to take full responsibility for any risks, injuries or damages known or unknown which I incur, or may incur, as a result of participation in any class at. 4. I knowingly and voluntarily waive any and all claims I have, or may at any time in the future have, against School of Burlesque its studio or any of the instructors, agents, or employees, for any injury or damage that I sustain as a result of my participation in a class.
By submitting this form you are consenting to the above
I consent to the above
I do
Mailing List
Yes please
No thank you
To recieve updates on classes, events and shows - Please note we will not pass on or share your details with any third parties and your information is stored in accordance with the data protection act 1998.
Payment: Payment must be recieved within 7 days to hold your place - Please pay online
Payment Type
I have paid for my course online
I am yet to pay for my course online - I agree to pay within 7 working days
If you wish to pay by cheque or cash please contact the office to arrange
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Home
Time Table
Class Registration
Parties
Staff Profiles
Gallery
Members
School Of Burlesque HD
Events
Show Rehursals
Pay
Reviews
Links
Contact
Agency