Dance And Fun - Registration Form

Please fill out the following form completely and send it by selecting the button "send".

Please read the conditions of participation at the bottom of this form.

Please fill out the partner column if registering as a couple.

	Student's Name	Partner's name (only Latin Ballroom)
	Please fill out all highlighted spaces!
Class
Day
Date
Location
First Name
Last Name
Date of Birth / Age
Male/Female
Partner
Parent/Guardian Name
Street
Apt/Suite
City / Postal Code
Phone Home
Phone Business
Cell Phone
E-Mail
Short Message

	By sending the registration form, you reserve a space in your dance class. A written confirmation of the logon isn't necessary. With our receipt of the logon your participation is protected.

Privacy Information: The above information is kept confidential by "Dance and Fun with Thomas & Heidrun". The

e-mail address will only be used for dance-related information (e.g., class information, parties/outings/events).
Cancellation Policy: Full refund minus a $10 administrative fee for cancellations at least 1 week prior to the

start date of the class.

By signing this form,
I understand that "Dance and Fun with Thomas & Heidrun" or its employees/contractors/helpers are not held responsible for any loss or theft of articles on the premises and are not held liable for injury or health risk sustained in the dance classes or any dance outings organized by "Dance and Fun with Thomas & Heidrun".

have read and understood the above Privacy Information and Cancellation Policy sections.

I allow pictures to be taken for promotional reasons.

Pay by cash or cheque (payable to “Thomas + Heidrun”). Send (do not fax) reg. form

and cheque to: Thomas and Heidrun Treutner, PO BOX 331, Bridgewater B4V 2W9

Tel: (902) 531-2276, danceandfun@eastlink.ca