DANCE THERAPEUTICS WITH DEB RUBIN WORKSHOPS ::::
JULY 21-22, 2009
REDWOOD RAKS, 824 L Street, Arcata
YOUR INFORMATION (check here if Shoshanna already has it: ______ )
Name:
Street Address:
City, State, ZIP:
Phone Number:
Email Address:
DESCRIPTION
Pre 7/10
After 7/10
Quantity
Total Price
Tuesday, July 21 7:00-9:00pm
Focus on the Upper Body
$30
$40
  
Wednesday, July 22 7:30-9:30pm
Focus on the Lower Body
$30
$40
    
Both Workshops
$55
$65
    
PAYMENT: Please DO NOT mail cash; send check or money order.
You may also bring this to any of Shoshanna's classes or to the event.
You may also send PayPal payment to dance@shoshannaland.com
TOTAL
  

LIABILITY RELEASE...
I understand that dance and dance-related activities present a risk of injury to the participant. I understand there is an inherent risk of injury that cannot be eliminated regardless of the care taken to avoid injury. I agree to assume any and all risks of injury or death, from any cause or source whatsoever in order to participate in or allow my child to participate in these activities.
I hereby release and forever discharge Shoshanna, Bellydancing by Shoshanna, Rose Anthony, Debra Rubin, Redwood Raks World Dance Studio, their predecessors and successors, employees, owners, agents, and assigns, and all other persons, corporations, and entities (including substitute dance instructors) from all claims, expenses, attorney fees, and causes of action or suits of any kind or nature associated with the participant’s involvement with any aspect of this event.
I HAVE CAREFULLY READ THIS AGREEMENT and fully understand its contents. I am aware that this is a RELEASE OF LIABILITY and sign of my own free will.

__________________________________________
Signature of Student over age of 18

Date: _________________________

__________________________________________
Signature of Parent/Guardian of Student under 18

Printed Name of Parent: _________________________
Please mail this along with your check or money order to: Shoshanna, P.O. Box 1086, Arcata, CA 95518
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