West Branch Parks and Recreation Zumba Class Monday 5:15pm April 4, 2022-May 2, 2022 Zumba Instructor: Abby Noelck
Please feel free to contact Parks and Recreation Director Melissa Russell at 319-930-0393 or melissa@westbranchiowa.org with questions or concerns.  
Class will be at West Branch Town Hall Mondays from 5:15pm-6:00pm.
Class numbers are limited to 6-15 participants.  
Registration deadline is April 1.  
Payments must be made with registration.  
Registration is not considered complete until payment is made.  
Refunds will not be made for missed classes.  
Refunds for the session will only be issued for a medical excuse.
Email *
You will receive a payment confirmation and a separate registration confirmation email.  Please hit submit at this end of the form so your registration is  recorded.
Participant Name *
Participant Phone Number *
Please enter the product number
Participant Mailing Address *
Emergency Contact *
Emergency Contact Phone Number *
I would like to register for the following session: *
I would like to register for a drop-in class.  The price per session is $10. I would like to register for the following drop in sessions.
Clear selection
A confirmation email will be sent regarding your email.  Please enter the confirmation number in the question below and make sure to hit submit to complete the registration form.
Before continuing please pay all required fees. https://www.govpaynow.com/gps/user/plc/a001l4
Payment confirmation is required.  Please enter payment online confirmation number or receipt or check number if payment was made in the West Branch City Office. *
Please let us know any medical issues or concerns we should be aware of.  Please consult a physician prior starting any exercise program.
By completing this agreement, I the participant, parent, and/or guardian under-stand that participation in this activity may result in some type of injury and protective equipment does not prevent all injuries to participants. I hereby give permission for my child, ward, or myself to participate in the below registered program and/or activity and certify that my child (or myself) is physically fit to join in the activities. I hereby waive, release, and agree not to hold the City of West Branch Parks and Recreation Department, West Branch Community School District, sponsors, supervisors, and volunteers liable for any injuries that may occur because of participation in these activities. I also give my permission for any photos/videos, etc. of these participants taken during a program to be used for future departmental promotional materials. Please take note and govern yourself accordingly. THE WEST BRANCH PARKS AND RECREATION DEPARTMENT AND THE CITY WEST BRANCH HAVE NO ACCIDENT INSURANCE TO PROTECT THE PARTICIPANTS.  Please print name below to show agreement. *
Other questions or concerns
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of City of West Branch, IA. Report Abuse
Google Forms