CLASS FORM/DISCLAIMER
Name………..……………………………..…. D.O.B:- ………............................................
ADDRESS:- …..…………………………………………………………….………………………………………
Telephone:- ................................................................................ Mobile:-..……………………………….
E-MAIL:- ..………………………….……………………………... OCCUPATION:-……………………........
CLASS/ES VENUE:- ……………………..…….....……..……….. TIME/S:-..….…..……..……………………
Please state below if you are pregnant or have any health problems (or concerns) – these can/may include: epilepsy, asthma, joint/bone disorders, heart problems, mental health problems or anything you feel I
should be aware of:- ………………………………………………………………………………………………..
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health advice
(you can sit out if you feel really tired, in pain or dizzy). If you have any doubts regarding your suitability to joining my Bellydance Classes, please seek the advice of a health professional. ugh your health, fitness and wellbeing are of the utmost importance, neither I (Paula Staunton), or anyone working on my behalf will take NO RESPONSIBILITY for any health problems, injuries or theftmay occur during any of my Classes, Workshops or Show Nights. I, Ishtar (Paula Staunton) have never had an injury in ten years; in fact, many people have reported dramatic improvements in various health problems as a result of attending my classes.
C CONDUCT:- Respect for me and fellow students is required to maintain attendance. Anyone disrupting
and spoiling the fun atmosphere of any of my Events will be asked to leave. I encourage a non-competitive and friendly
atmosphere which makes people feel good and helps them to learn, I expect students to join in with this approach.
Course/Workshop/Taster fees are non-refundable
a) Please indicate how you would like me to contact you if coming to class is a secret:-
…………………………………………………………………………………………………………………….
b) How did you find out about the class? ………………………………………………………………………..
c) What is/are the main reason/s for attending my class? ………………………………………………………..
Are you interested in attending:- classes and Workshops on Bellydance, Goddess spirituality, Yoga, Residential abroad, Bellydance Shows or purchasing music (please underline)
I TAKE FULL RESPONSIBILITY FOR MY OWN HEALTH and agree with the Code of Conduct and terms for Ishtars BellydanceClasses/Workshops/Show nights
SIGNED:- …………………………………………………………………………………………
* I wish to order Ishtar’s Video (£15)/DVD (£20) - Qty Required: ………..
For more information just ask or go to www.ishtar.tv
FOR OFFICIAL USE ONLY
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