InSight Fitness Registration | Vision Dance Center

InSight Fitness Program by VDC Registration

First name

Last name

Date of Birth

Parent/Guardian Name (if under 18)

Secondary Email

Phone

Alternate Phone

Street Address

City

State

ZIP

WAIVER/RELEASE OF LIABILITY

The practice of fitness workouts and classes involves the risk of physical injury (with bruises being the most likely injury and broken bones or other more serious physical injuries also being possible.) Understanding this I declare:

That I am willing to accept responsibility for such an eventuality, and;
That I have adequate medical insurance for such an eventuality, and;
That I will not hold any club, member, instructor, or the owners or operators of any facility in which I might practice liable for any injury that I might sustain while working out in or outside of the studio.

Further, I understand the physical demand of this activity and the practice required for its development and mastery. As a consideration for my own safety and enjoyment, as well as that of other students, I commit to dedicate necessary practice of the instructions and techniques given to me in class.

Your Signature

PHOTO RELEASE

I hereby grant permission to Vision Dance Center to use photographs and/or video of me taken during InSight Fitness program classes at Vision Dance Center's studios and/or its events, workshops, performances, or other VDC hosted functions in publications, news releases, online, and in other communications related to the mission of InSight Fitness and Vision Dance Center.

Your Signature

Name/Loction (if applicable)

Howmany lsses per week are yo intereste i takig?

Are you planning on being in the area for the next 6 to 12 months?

Yes

* The form may take a few seconds to submit. If the "Register" button goes grey, but you are not redirected to a confirmation page after a minute, please email info@visiondancecenter.org to confirm we have received your registration.