Christian Hip Hop Dance Registration Form
Please fill out form and submit
Registration will be incomplete if not filled out completely

 Date:

Last Name:   Name:  

Birth Date:    Parents Name (if applicable)

Address:   Apt. #

City:    State: Zip:

Home Phone: Cell Phone:

Contact Email:

Do you have any health concerns that we should be aware? If yes, please explain:

Workshop Classes - Check your selection


 Beginning/Intermediate Class - 3:00-4:30 PM - Cost: $12.00

Advanced Class - 4:30 - 6 PM - Cost: $12.00

Both - $20.00 (Highly recommend this option, the best for your $$)

Are you interested in auditioning for PURE-Energy Christian Hip Hop Performing Group (must be between the ages of 10-12): Will send more details if you are interested.


PLEASE MAIL PAYMENT TO:

Righteous Fellowship

PO Box 68346 - Seattle, WA  98168

CASH OR CHECK ONLY, Please.  (Checks Payable to: Righteous Dance Company)
 $25.00 charge on all returned checks!
 Please Note: Registration Fees are non-refundable

IN CASE OF EMERGENCY:
Name: Phone:

Relationship:

I recognize that potentially injuries can occur in any activity involving height or motion, including dance or other related activities. I hereby release Righteous Dance Company, its owners, volunteers, assistants and guest artists  from any and all liability claims, demands, or causes of action whatsoever from any and all damages suffered by the participant while under the instruction, supervision, or control of Righteous Dance Company. As parent or legal guardian of the aforementioned person, I hereby agree to individually provide for possible future medical expenses that may be incurred by the participant as a result of any injury sustained while participating in dance with Righteous Dance Company.  The Student further certifies that he or she is in good physical health and is able to undertake and engage in the physical exercise activities in which he or she chooses to participate, including participation in any dance / exercise course or program.  This acknowledgement of risk and waiver of liability has been read thoroughly and understood completely, and is signed voluntarily as to its content and intent.

Yes, I accept the terms above (equates to signature of Student or Parent / Guardian, if minor)