Registration Form Austin

Bollywood Shake 2012 Class Registration Form(Austin Locations)

Please fill in the below form to REGISTER !!

Payment can be made on the first day of class by cash or check or by credit card at our website. ***We now also accept credit cards over the phone and at our main Anderson Mill Rd studio.***

Check out further details on schedule, rates on our website at http://www.bollywoodshake.com/schedule.html and http://www.bollywoodshake.com/rates.html respectively.

For additional questions, e-mail support@bollywoodshake.com or call 512-67-SHAKE or 512-67-74253.

E-mail Address: *

Last Name *

First Name *

Contact Phone Number *

Address

City

State

Zip Code

Date of Birth (for Kids only)

Class Location *

Type of class *

Start Date (approximate if not sure) *

Day of the week (required for once a week dance classes)

Enrollment Duration *

Method of Payment *

Autopay
Credit Card
Check
Cash
Online (pay on next page)
LivingSocial
Groupon

Comments

I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE BELOW STATEMENTS. (Please refer to the LIABILITY WAIVER below) ENTER YOUR INITIALS *

* Required

LIABILITY WAIVER:

I have enrolled in the Bollywood dance classes offered by Bollywood Shake. I recognize that the classes may involve strenuous physical activity including, but not limited to, dancing, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this dance program.” “In consideration of my participation in this program, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release the above named Institution, its governing board, officers, employees and representatives from any liability to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my participation in the Activity, whether caused by negligence of the Institution, its governing board, officers, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless the Institution and its governing board, officers, employees, and representatives from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in the described Activity.”

TERMS AND CONDITIONS:
●      Classes purchased are non-refundable and non-transferable.
●      Make-up classes are allowed in special circumstances. Approval from instructor required.
●      Class instructors, levels, timings and rules and regulations are subject to change without prior notice and all decisions made by Bollywood Shake will be final and binding.
●      Bollywood Shake reserves the right to cancel and/or reschedule a particular class due to unforeseen circumstances.