"Virtual Zumba® with Lori" Registration Form
Please fill out prior to first class. Only need to fill out once even if taking multiple classes.

If you have any questions please email  lori.salame@gmail.com

Zoom Link and password will be emailed to you after receiving this form.

Please bring a water bottle, wear athletic shoes and a have clear, open space to move in!

Thank you!
Sign in to Google to save your progress. Learn more
Email *
Registrant First and Last Name: *
Birthday (optional):
MM
/
DD
/
YYYY
Guardian First and Last Name (if registrant is a minor):
Phone Number: *
Emergency Contact Name and Phone Number: *
Any medical concerns or issues to be aware of:
It is strongly recommended that you, the participant, consult with your physician before beginning any exercise program. You should be in good physical condition and be able to participate in the exercise. You should understand that when participating in any exercise or exercise program, there is the possibility of physical injury. If you engage in this exercise or exercise program, you agree that you do so at your own risk, are voluntarily participating in these activities, assume all risk of injury to yourself, and agree to release and discharge Lori Salame, and any other Zumba instructors and/or participants from any and all claims or causes of action, known or unknown, arising out of all Zumba classes that you are participating in. It is recommended that the camera stays on during the Virtual classes so the instructor can see the participants. If the participant is a minor, parental supervision is advised. *
The instructor and/or participants may choose to take pictures/videos before, during, or after the class. Participants are asked not to record or share entire songs/choreographies due to copyright and in order to respect the choreographers and Zumba, If you would like to record small portions (under 1 minute) or take pictures, please do so respectfully of other participants and please send anything captured to Lori Salame. If you share anything on Instagram, please tag @lori_zumba. Lori Salame and other instructors or participants may capture moments of classes, before, during, or after, by video or pictures, to share on social media. I hereby grant Lori Salame and others permission to use my likeness in a photograph or video in any and all of its publications without payment or any other consideration. Lori Salame cannot be held responsible for any pictures or recordings made by participating members. Thank you for your understanding. *
Favourite type of music or songs (optional):
I, the participant or the guardian of the minor participant, agree that all of the information entered in this form is true to the best of my knowledge. *
Today's Date: *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms