Street: ____________________________________________________

City and zip: _______________________________________________

Phone #: __________________ e-mail:__________________________

Please indicate which class you are registering for:

___ Mondays, Basic Level 1, 8:40 - 9:40 PM
___ Wednesdays, Essentials of Tribal Belly Dance, 8:00 - 9:15 PM

Fee: $65 prepaid per 5 week session. All returning Blue Moon students and Namaste Yoga Center students registering and prepaying for the session receive a 10% discount off their fees (= $58.50 per pre-paid 5 week session). Please be sure to indicate on your registration form if you qualify for this discount.

___ I am a returning Blue Moon Dance Company student
___ I am a current Namaste Yoga Center student

Registrants must be at least 14 years old to participate in the classes. Class fees are non-refundable and non-transferrable.

Please mail checks payable to Blue Moon Dance Company to:
104 Southwold Drive
Cary, NC 27519

WAIVER

Please read carefully before signing.

Participation in any Blue Moon Dance Company activity and use of any recreational facilities involves a risk of accidental injury despite all safety precautions. I/we, as an individual or as a parent or guardian of the participants named herein, assume all risks and hazards incidental to the activities, and release from responsibility and agreed to indemnify and hold harmless Blue Moon Dance Company for any illness or injury to me or my minor child/ward occurring during my participation in any activity conducted by Blue Moon Dance Company.

Sign below only after carefully reading the above.

Signature (parent if minor) ________________________________________________________

Date _______________

Note: Signature is required as a condition of registration.

****************************************************************************************************************************************** For Blue Moon Dance Company use only:
Session registered for:

Method of payment: ____ Cash ____ Check