Cairo Fusion Registration Form

Name______________________________________________________  Age________

Mailing Address__________________________________________________________

E-Mail Address________________________________  Phone #___________________

Have you taken dance classes before?  If so, what kind & how long?_________________

________________________________________________________________________

Do you have any health issues we should know about?  (i.e. injuries, heart conditions, etc. ________________________________________________________________________

Are you pregnant?____________  How far along?____________________

What are your goals with dance classes?  (please check all that apply)

Performance _______       For Fun _______     Exercise________     Other__________________

How did you hear about Cairo Fusion? ______________________________________________

Have you seen a Cairo Fusion performance before? ___________

Which class are you registering for at this time?

    Belly Buster    

Each class is $16/Week or $50/Month  --- One 1 hr. class weekly

  Monday 6:00 -7:00 pm

Intro to Cairo Fusion Basics-Technique & Theory Classes: 

 Each class is $60/Month   One 1.5 hr. class weekly

Level 1 & 2 - Suspended until further notice

                 Classes are filled on a first-come-first-served basis.  If class is filled, you will be notified there is an opening.  All fees are due at the first class of each month. 

Fees are non-refundable after the first class of each month. 

Mail to:  Samira, PO Box 50035, Boise, ID  83705

All classes are located at MDDDS, 4419 Marvin St.     

Release of Liability & Indemnity Agreement

-I agree to release, indemnify & hold Cairo Fusion, Sunnie Simmons, Jeanne Wendland, any/all landlords, studio owners, contractors & employees, harmless from any & all liability claims, actions, judgments, damages or injuries of any kind what so ever, to the participant and/or her property arising from participation in the activities for which the participant is registered. 

-I further acknowledge that I have familiarized myself with the description of the activities & understand the hazards& any personal physical limitations & knowingly assume all risks.

-I certify that I am over the age of 18 & a responsible adult.

-I understand all of Cairo Fusion’s policies of fees, payments, performances, etc. and accept those policies.  (Copy provided at first class attended)

Student Name________________________________________Age______

Signature of Consent:  (If registered is under 18 yrs. of age.)

__________________________________________________Date_______

Class ________________________________________________________