REGISTRATION FORM

AussieTwerk Classes/Courses & Workshops Registration Form

AUSSIETWERK /VOGUE AUSTRALIA ENROLMENT FORM 2020

* Indicates required field

Name *

First

Last

Email *

Phone Number *

How did you hear about us? *

What Class/Course/Workshop are you registering for? *

MEDICAL REPORT

EMERGENCY CONTACT DETAILS NAME OF THE PERSON *

First

Last

Phone Number *

Email *

What is your training background? *

Dance Sport Circus Other

What training are you currently undertaking and how many hours/wk? *

Have you received a medical clearance from your doctor/physio this year? Please list any regular medications you are taking *

Do you suffer from Asthma? *

Yes No

Please choose if you ever had: *

Do you have any allergies? (including strapping tape, foods, dust, ice, medications) *

INJURY DETAILS

Have you had any injuries this year? If yes, please list with approximate date. *

Have you sustained a fracture or dislocation in the last 3 years? If yes, please list with approximate date: *

Do you require any specific taping for a previous injury? If yes, please list: *

Are there any past injuries or operations? If yes, please list with approximate date: *

Have you ever had a head, neck or spinal injury? If yes, please list with approximate date: *

Any other conditions we should be aware of?? *

Are you of the legal age in Australia? *

AGREEMENT

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

If any of the above medical or contact details changes it is your responsibility to inform AussieTwerk. To the best of my knowledge, all information contained on this form is true and correct. *

You are advised to consult your physician before beginning this or any dance/fitness program. Do not attempt to perform any movement shown or described on AussieTwerk / Vogue Australia classes or courses/workshops, unless you are certain of your ability to implement it without incurring strain or injury. The owner of AussieTwerk/Vogue Australia, instructor disclaim any liability for losses or injures sustained in connection with any advice, activity or demonstration on AussieTwerk classes, courses and workshops *

If you book into a Twerk class/workshop or TwerkZotic/Heels class/workshop by phone, email, facebook or at your previous training session and cancel with less than 24 hours notice, a $15 cancellation fee will be charged at the beginning of your next session without presentation of a medical certificate. For private lessons a %50 cancellation fee applies with less than 24Hours notice. This is to contribute to the costs of studio hire and tuition. If you are sick or injured for an extended period, course payments/memberships can be extended by negotiation. *

If you buy a package of 11 Classes for $150, the package remains active for 3 months ONLY from the day of your first class. *

1. I do understand that ‘Twerking’ is a type of dancing in which an individual dances to music in a sexually provacative manner involving thrusting hip movements and a low squatting stance and it’s my choice to learn this type of dancing on AussieTwerk classes/workshops/courses or Hens/Birthday Parties 2. Everytime we have a group lesson/class or workshop, we take a photo of all girls attended the class/lesson or workshop. It is your responsibility to let us know if you don't want to be captured. Dance instructor will also ask you at the end of the class if you want to be on the photo with other students. If you agreed to be on the photo with other students, we have the full right to post it on our Facebook, Instagram pages and on our website "AussieTwerk.com" to promote our classes/services. The content of the photo can have a sexually provocative manner. AussieTwerk reserve the right to refuse entry to anyone who wants to join our Twerkshop/ Twerk Class/Twerk Hens/ Twerk Party or Twerk Individual class without providing any explanation why. *

I AGREE to AussieTwerk/Vogue Dance Australia Class/Course/Workshop/Hens Terms & Conditions

ENTER YOUR INITIALS TO CERTIFY THAT YOU AGREE to our TERMS & CONDITIONS *

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