Class Registration Form Please enable JavaScript in your browser to complete this form.Select One *New StudentReturning StudentName *FirstLastEmail *Phone *Age *Under 18 yrs18 - 35 yrs35 - 50 yrsOver 50 yrsEmergency Contact Information *FirstLastEmergency Contact Phone *I'm Interested in the Following Class(es)Zumba GoldZumba BasicClass Fee(s)1 - Class $10.005- Classes $45.0010 - Classes $90.00NOTE: All payments are non-refundable, non-creditable and non-transferable. NO EXCEPTIONS.Payment Options Paypal at: Shinedancefitness@outlook.comVenmo at: DonnaL-JamesonZelle at: Shinedancefitness@outlook.comCash App at: $DJameson602LIABILITY DISCLAIMER/CONSENTPHOTO AND VIDEO CONSENT *I GIVE CONSENT to be photographed and/or videotaped. These may be used without compensation in a public presentationI DO NOT give consent to be photographed and or videotaped.Acknowledgement *I have read and accept the conditions of the Liability Disclaimer/Consent Signature *Clear SignatureDate *Submit