Registration

Name: *

First

Last

Email: *

Phone *

Your Birthdate (mm/dd/yy) *

You agree to our terms *

City: *

State:

Zip Code

Class Choice: *

Awaken the Goddess - Open Level Class with Jess (Saturdays at 10am)
The Belladies Performance Troupe - Intermediate/Advanced Level (Saturdays at 11am)
Sundays with Reyns - Open Level Zumba & Fusion Belly Dance (Classes will be on Sundays beginning January 2024)
BOTH Saturday Classes with Jess (Awaken the Goddess & The Belladies)
Saturday Classes with Jess AND Sundays with Reyns
All of the above (Saturdays, Sundays & Troupe)

Marital Status

Children:

Age(s) of Child(ren):

Pets:

Describe Pets

Occupation and Place of Employment:

Hobbies / Special Interests:

Any past dance, karate, or theater experience or training?

If Yes, please describe:

Do you play any musical instruments?

If Yes, please describe:

Do you have any physical constraints, illnesses or past injuries? If yes, please list below:

How did you hear about us? (Google? An event? FaceBook? Instagram? Referral?

Do you have any concerns or questions?

Are you interested in continuing lessons and perhaps joining a troupe?

Would you like to receive the weekly class reminder and updates via email? *

**Weekly emails are simply a reminder for upcoming classes, events, and weekly belly dance inspiration to keep you motivated and inspired!

Events in December 2024