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metabellydance@googlemail.com
07875794498
Metamorphosis Belly Dance
Liability Waiver
First name
Last name
Email
Are you in good health to participate in physical activities?
No
Yes
Please specify anything we should know about
Emergency Contact Name
Emergency Contact Number
Student Initials
I declare that the info I’ve provided is accurate & complete
I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.
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