Registration
Let It Move You - There are a lot of ways to lose way and feel fit - some are just more fun!!! Join the Ultimate Dance-Fitness Partly and beats a boring old workout any day. Zumba classes are starting at United. Second Session begins the first week in September through the end of the year EVERY MONDAY AND WEDNESDAY NIGHTS 7-8 P.M. The cost is $45 plus tax for a punch card with 10 classes on it. Register here through this site. See you for fun and fitness!
Event:
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Family Information
First Name:* Last Name: *
Type*
Home Phone:* Click to Enter an International Number Cell #: Click to Enter an International Number Work #: Click to Enter an International Number
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City: * State: * Zip: *
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Students entered below will be added to your family's account
 
Questions/Options:
Have you ever attended a Zumba class before (checked=yes)
Do you have any health concerns that we should know about? If so please list -
 
Additional Information:
 
Legal Liability Waiver
Legal Liability and Medical Release Form
" I am the legal guardian/parent or am of legal age and I fully understand that I am responsible for payment of expenses incurred relating to the Zumba Class held at the United Center.
" I certify that my child or myself is physically capable of participating in the Zumba Class with instructor Leah Applebee and the United Center and have no previous injuries that will effect participation.
" I hereby have been forewarned that participation in this class has the following non-exhaustive list of particular risks and injuries including but not limited to: sprains, strains, abrasions, dislocations, fractures, concussions, contusions, blisters, head and neck injuries, illness and even possible death.
" Having been forewarned, I assume all risk and full responsibility in connection with the United Center and Instructor Leah Applebee and hereby release all instructors, staff, volunteers, practice and performance facilities, and others involved with the Zumba Class at the United Center from any injury that may befall myself or my child.
" I agree to hold harmless the United Center or United All Stars, L.L.C. for any injury incurred as a result of my child's or myself's participation.
" I am fully aware of the inherent risks of exercise and dance and am willing to accept these risks to participant in the Zumba Class.
" I understand that United All Stars, L.L.C. strive to provide the maximum in safety precautions and student training.
" I give permission for any medical treatment necessary in the event of illness or injury at the clinic while participating at the United Center.
" I have provided accurate information to the best of my knowledge regarding myself or my child's health and have alerted the staff with any medical concerns.
" I have read, agree to, and fully understand the information and risks and agree to all payments required for myself or my child as a participant at the United Center.
" I grant permission to be photographed, videotaped, or interviewed for the website, publications or press.

I've read the above and agree.
 
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Credit Card Verification:
   
Card Number: *  
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Nickname:
Card Expiration Month: *   Exp Year: *
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