Balboa/Dips and Tricks Class Registration Form

________________________________
Name:_____________________________________

Evening phone:________________                  Day Phone:___________________

E-mail:________________________      

Partner's name (if you are registering with one): ___________________________

Class (Check all that apply):    

Balboa  (8pm-9pm, October 3rd)
     __ Lead     __ Follow

Dips and Tricks (9pm-10pm, October 3rd)
     __ Lead     __ Follow

__ $45/person
__ $80/couple (one class only) or person (both classes)  
__ $150/couple (both classes)  

The student/participant recognizes the risk of accident or injury inherent in an exercise or dance program and waives, releases, and holds harmless the Cambridge YWCA, Steve Bailey, Sara Fajkowski, their heirs, assigns, instructors, employees and independent contractors from liability for injury, damages, or claims arising from participation in any program with Steve Bailey and Sara Fajkowski.  Furthermore, the student/participant agrees to practice all steps with caution and in full awareness of both his/her partner and those around him/her.

I have read the above information and agree to abide by its contents.

Name:_____________________________   Date:____________
Name:_____________________________   Date:____________

________________________________
Please print out this form and send it along with payment to:

Steve Bailey
attn: Balboa/Dips and Tricks Registration
47 Symphony Rd
Boston, MA 02115