Sign Me Up!

Thank you for your response. ✨

Participant Information:

Name

Keep me updated on upcoming events and news (optional)

Phone

Classes:

Choose all that apply(required)

SUNDAY @ 6 PM | $10 | Charleville Dancehouse THURSDAY @ 6 PM | $10 | Charleville Dancehouse Let me know when more classes are available

In case of emergency, who should we contact?

Emergency Contact:

Emergency Contact Phone Number

Liability Waiver and Terms & Conditions

I have read and agree to abide by the Liability Waiver and Terms & Conditions found below.

I grant permission to SHiNE Dance Fitness™ to use photos and videos taken during class for promotional purposes only (optional)

Medical Conditions (if applicable):

Liability Waiver / Terms & Conditions

As a participant or the parent/legal guardian of the participant checking the box above, I have voluntarily elected to participate (or have my child participate) in a SHiNE Dance Fitness™ class(es). I acknowledge that, as with other athletic activities, there are risks inherent in dance and fitness training including, without limitation, the risk of injury to bones, joints, tendons, ligaments, and muscles. If I experience an injury or have concerns about a possible injury, I should and will promptly consult a physician and notify my instructor.

By checking the box above, I assume the risk related to dance and or fitness training during a SHiNE Dance Fitness™ class(es). I hereby release Kendall Nielson (Owner of SHiNE Dance Fitness LLC) and the instructor, Leilani Seeto, teaching SHiNE Dance Fitness™ from, and hold harmless against, all claims (including claims of negligence), actions, damages, liabilities, and expenses (including reasonable attorneys’ fees) (collectively “Claims”) arising out of or resulting from the dance or fitness class and the use of the studio facility (including, without limitation, personal injury and the loss or destruction of personal injury and the loss or destruction of personal property).