Name *

First Name

Last Name

Phone *

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What classes are you interested in?

Intro to Kathak: 6 Week Beginner Series - Group Classes

Bollywood Fusion Class - Group Classes

Private (1-on-1 ) Classes

$5 Trial Class

Parent/ Guardian name (if student age <18 years)

First Name

Last Name

Parent/ Guardian mobile number

(Required if <18 years)

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Release and Hold Harmless Agreement *

Thank you for joining our online dance classes! Before participating, please review and confirm the following: · I confirm that I (or my child, if under 18) am in good physical health and know of no medical condition that would prevent safe participation in these classes. If I have any concerns about physical readiness, I will consult a doctor before starting. · I understand that dance involves movement and carries a risk of injury. I agree to release and hold harmless Bolly-Kathak Dance Rhythms, and the instructor, Sonal Purohit, from any and all claims for injuries, damages, or losses that may occur as a result of participation in these classes. · These classes are traditionally danced barefoot. I will ensure the floor I (or my child) use(s) is clear, even, and free from obstacles, splinters, or anything that could cause injury, slipping or falling. If I or my child choose(s) to wear socks, I understand this may increase the risk of slipping and agree to participate carefully. · I give permission for the school and instructor to capture screenshots, photos, or short video clips from class sessions for educational or promotional purposes, unless I notify the instructor in writing that I prefer not to be included.

I have read, understood, and agree to the terms of the Release and Hold Harmless Agreement. I certify that I am either the student (over 18 years of age) or the parent/legal guardian of the student. I consent to my typed name serving as my electronic signature.

Date *

MM

DD

YYYY