Bellydance Class Registration for Mondays (Mar/Apr 2024) at Strictly Ballroom with Amy "Kiyaana"

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Please complete this form to sign up for Amy "Kiyaana" Limbrick's 6:30 pm or 7:30 pm class held on Monday nights at Strictly Ballroom (off of Lafayette Blvd, 125 Olde Greenwich Dr #190, 22408). This registration will save a spot for you in the class (space is limited to 15).

7 classes on March 11, 18, 25, April 1, 8, 15, 22 (Apr 29 might be used as a make up class, if needed)
During this session, students will learn technique, combos, and explore special topics.

6:30 pm - Beginner/Adv Beginner Class - all levels welcome

7:30 pm - Intermediate/Advanced Class - permission required to join

Special session rate of $98 for 7 classes

$18 drop-in

Payment can be made directly to Amy (cash/check) or via PayPal. If paying via PayPal, find buttons here http://www.kiyaana.com/pay-for-monday-classes. Ask me for Venmo or Zelle info.

Please note that refunds are not possible once the session has started.

If you need to miss a class during the session, the videos provided via email each week will help you learn what you missed. Fees paid for a session do not transfer to another session due to missed classes.

These classes are group classes. The minimum number of students is 3, the maximum is 15.

Age requirement: age 16 and up. Can be age 12-15 if accompanied by a companion age 16+ that is also taking the class.

There is no child care available at Strictly Ballroom.

Class observations are not allowed. All present during the class are expected to participate, unless advance permission has been given (for example, if an enrolled student has temporary injury, s/he may observe.)

First Name *

Last Name *

Email Address *

Which class would you like to take? *

6:30 pm Intro & Essentials (Beginner/Adv Beginner) on Mondays at Strictly Ballroom

7:30 pm Continuing Bellydance (Intermediate/Advanced, required for new students) on Mondays at Strictly Ballroom

Select session with payment type: *

7 classes on March 11, 18, 25, April 1, 8, 15, 22 for $98

Drop in on March 11, 18, 25, April 1, 8, 15, 22 for $18

Phone Number (used for notifications of class cancellations) *

Emergency Contact Name

Emergency Contact Phone Number

Do you have any specific physical limitations? (If "yes," please describe.) *

Liability Disclaimer: Bellydance is a physical activity. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in bellydancing and/or exercise classes. I represent that I am in good health and suffer from no physical impairment that would limit my participation. I understand that I am participating in bellydance at my own risk. I agree that Amy "Kiyaana" Limbrick is not liable for any personal injury that I may suffer during class or at any related function. I hereby agree to the above conditions. (Please type your name as your signature to affirm this.) *

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