Class Registration Form
Please fill out and return, with your tuition included, to Nita Collins.  

PLEASE READ THE CLASS POLICIES ON THE ABOUT CLASSES PAGE. THANK YOU.

Nita Collins
32 Grouse Crescent
Whitehorse, Yukon Y1A 6B5
456-2862
www.celebrationsbellydance.com

Name  
Mailing Address  
Phone  
Email Address  
Health info I should know about  
Prior dance experience if any  
Which class are you registering for?
  • Sunday Level 1
  • Sunday Level 2
  • Sunday Level 3
  •  Note about City classes: I occasionally teach CityRec classes as an employee of the CityRec program. Information and registration for these classes are through the City of Whitehorse. Phone the CityRec department for details.

Three or Four times per year I send out an e-newsletter containing news, class notices and notices of coming events that are of interest to students. Your email address is automatically included on my mail list. If you do not want to receive any notices from me, please indicate so.

Bellydance, like any other dance form or sport activity, contains an inherent risk of injury.  While you may experience soreness the next day because your muscles are unused to this activity, pain felt while executing the movements is not acceptable, and you should STOP immediately and speak with your instructor. Movements are taught as properly and safely as possible with care and attention to proper form; however, you are ultimately responsible for your own safety and injury prevention. Neither I nor anyone working with, for or under me, nor the does the facility where class and/or class events are held, assume any liability for injuries incurred by you or others while you are taking classes or participating in class events.

Please read and sign:

I recognize the risks of physical injury inherent in dance and training and I am willing to assume those risks. I agree that I will not hold Juanita Collins or teachers hired, contracted or assigned by her, nor the facility where class and/or class events are held, liable for injuries sustained or illness contracted by me while I am a student and/or participant in class, in class events or otherwise. I agree to indemnify Juanita Collins and teachers hired, contracted or assigned by her of liabilities, costs, and judgments arising from acts of omissions of the undersigned, which result in injury or damage to any person or party.

Signature______________________________________Date__________________________________________