Registration

Name: *

First

Last

Email: *

Phone *

Your Birthdate (mm/dd/yy) *

You agree to our terms *

Street Address:

City: *

State:

Zip Code

Class Choice: *

Choreography Class with Bold Baladi (Jess) - Saturday 10-11am; Class Card: 3 minimum at $10 per class (no expiration date) or $15 per lesson (drop in)
Belly Dance with Bold Baladi (Jess) - Friday 4-5pm; Class Card: 3 minimum at $10 per class (no expiration date or $15 per lesson (drop in)
Basic Fundamentals w/Gypsy - (to be determined) $60 per six-week session -or- $15 per lesson
Troupe Class w/Gypsy (by invitation) - (to be determined) $60 per six-week session -or- $15 per lesson

***If you are interested in joining Bold Baladi classes, please contact Jess directly at boldbaladi@gmail.com

Marital Status

Children:

Age(s) of Child(ren):

Pets:

Describe Pets

Occupation and Place of Employment:

Hobbies / Special Interests:

Any past dance 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 my class and/or web site? (yellow pages, internet search, newspaper/magazine ad. If referred by friend please list name):

Do you have any concerns or questions?

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

Please confirm Beginner Basics session (beginning date) for which you are registering:

**If you are interested in joining Bold Baladi classes, please contact Jess directly at boldbaladi@gmail.com

Belly Dance Basics DVD