firstname.lastname@example.org | 703.678.8443
BANG Power Dance™
Tell us what you Think!
1 on 1 Training / Boot Camp
How did you hear about class?
If you were referred, please provide name so we can reward them!
I would like to register for:
Bang Power Dance
I would like to be added to the mailing list (monthly newsletter, class updates, schedule, etc)
I wish to participate in the above-described activity. I understand that I do so at my own risk. In exchangefor being permitted to participate in this activity, I hereby release and waive Get Heidi Fit, LLC and Heidi Inthavong, and any corporations or entities affiliated with the foregoing from liability for any and all loss, damage, injuries, claims, demands, lawsuits, expenses and any other liability of any kind, of or to me or any other person, directly or indirectly arising out of or in connection with my participation in or attendance in the above-described activity. I further agree to hold harmless, indemnify and reimburse the Released Parties from and for any sums, costs, or expenses incurred by any of the Released Parties or paid by them to any person (including me or my insurers) in connection with any accident, loss, damage, or injury sustained by me or others in connection with my attendance at or participation in the above-described activity. This means that I will reimburse the Released Parties if anyone makes a claim against them based on damages or injuries I may suffer. Returning this form (completed) to Get Heidi Fit, via written or electronic media shall constitute conclusive proof that I agree to the terms and conditions of this Waiver & Release Form. I acknowledge my responsibility to retain a completed copy of this agreement for my records.
Please list any injuries/conditions that we should be aware of:
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