Zanzibar Studio Bellydance Registration Form      

To ensure your space in a class, please complete and sign this form and mail it, along with your deposit,
payable to Zanzibar Studio, to:


Zanzibar Studio, 600 Georgia Ave., Suite B1, Chattanooga, TN 37402

To register to hold your spot , send a deposit of half of the class total (for example: if you are choosing one class per week and the cost is $80, your deposit will be $40, if you are attending two classes per week and the cost is $155, then your deposit will be $77.50 ,etc). The balance of your tuition will be due on the first day of class. If you cannot pay the balance in full on the first week, do allow payments up until the third week of class. A $10 late fee will be applied to all balances that are paid after the 3rd week of classes for EACH WEEK your payment is late . (Ex: if you pay the 5th week, a $20 fee will be added) Because of the large volume of registrations we receive, you will not receive a call from us unless the class you have registered for is full. If you do not hear from us, assume your spot is confirmed. If the class you wish to register for is full, we will notify you and invite you to join another class, or put your name on the waiting list. If no other class time works for you, your deposit will be returned.

PLEASE NOTE:
Refunds given only if we are notified of cancellation BEFORE the first day of class. We will be unable to refund you if you cancel after this time. PLEASE MAKE SURE THAT YOUR WORK AND FAMILY SCHEDULE ALLOW YOU TO COMMIT TO THE ENTIRE SESSION BEFORE YOU REGISTER. Thank you.

What class or classes you are registering for?

 

Session (what date session starts on): ______________________

 

Day of your class (day of the week you will be attending): _________________________

 

Time of your class (what time of day will you be attending): _________________________

 

Or check here if you are attending Unlimited Classes or 10 class card: _______


Full Name (First/Last):___________________________________


Email Address (please print clearly): ____________________________________________


Would you like to be added to our mailing list (circle one)?   YES, PLEASE     NO, THANKS


(We will only send emails about upcoming performances, classes, and workshops only.)


Phone Number: (______)_________-__________


Street Address: ________________________________________ Apt #: _____________


City: _____________________________ 
State:_________  Zip Code:_____________________ 


How did you find out about us?______________________________________


If it was a brochure, where did you see it?_________________________

 

Please tell us about any known medical problems and past injuries you have:

________________________________________________________________________


________________________________________________________________________ 

 

I assume the risk of liability arising from my participation, or the participation of a minor child as their parent or legal guardian, with Zanzibar Studio and all instructors associated with said company. I agree to indemnify, hold safe and harmless against, and defend Zanzibar Studio,Lacy Dickerson , employees, and instructors from any and all claims, costs, expenses, damage, and liability arising from or pertaining to my participation in this class. I further completely release Zanzibar Studio and participating instructors from any present or future legal responsibility for any negligence which may be found against them arising from my participation, or the participation of a minor child as their parent or legal guardian, in this class. I understand that I should speak with a medical professional before participating in any form of exercise, including any classes at Zanzibar Studio. I further understand that while Zanzibar Studio makes every effort to create a safe environment for everyone, that there is no security in effect in the studio and that Zanzibar Studio will not be held responsible for any damages incurred by the illegal actions of myself, another student, or a third party that happen in or near the studio. By signing this form, you understand and are agreeing to the terms listed above. A signed copy must be on file with the instructor before you begin attending class. It can be turned in at the beginning of the first class. For ongoing students, this waiver will be kept on file. It only needs to be signed once.

 

Signature:____________________________________________________ Date: _____________________

 

Parent / Legal Guardian Signature (if under 18):________________________

 

Name of minor:________________________________________________