Enlightenment Dance Company
Class Registration Form
Please use your browser's [Print] controls to print this page, then fill in and mail to the address below.
Use this space to specify class, location, time. Attach additional sheet if needed.
 
I have read the following: Please send a minimum payment of $15 dollars with this form. This fee will be applied towards your first class payment. If you miss a class from the 12 class program, you need to do a private class in order to graduate with the group. Payment is non refundable and it is valid for a 6 months period, from the date of purchase. These are adult classes; no children under 16 years of age. 16 year old must have written parental consent. Thank you for choosing Enlightenment Dance!
Full name:  
Dance name:  
Street Address:  
City/State/Zip   Country:
Telephone & best time to call:   email:
Please indicate your choice of payment:

$150 for 12 class series, paid in full at the first class day       
$85 1 of 2 payments for 12 class series, first payment at first class, second payment 30 days later.
$50 per month
$15 per class
other amount for Workshops or Special events $_______
 
Enclosed: Check   Money order            Amount:_____________________
I have already paid via PayPal- Copy of receipt attached.   Amount:_____________________
Activities Release: I take responsibility for my Physical well-being. I represent that I am Physically and Mentally able to take Enlightenment Dance classes, workshops and to dance or participate on any event. I release Enlightenment Dance Company, Rosane Gibson and any other sponsors or representatives and successors from all claims or liabilities arising out of my participation in any sponsored activity.

Signed: ______________________________________________________    Date: __________________
Please make check or money order payable to
Enlightenment Dance Company and send to

Enlightenment Dance Company
1037 NE 131st Street
North Miami FL 33161

Phone 863- 585-8264   email: hozuhni@enlightenmentdance.com