Island Shakedown Registration Form

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April 11th, 2023 - May 4th, 2023
This online form must be completed and the one-time tuition fee of $100 must be paid via Zelle (480) 415-3603, Venmo @tamaliientertainment, CashApp $tamaliientertainment with your registration name in the description for "Island Shakedown" in order to confirm your registration for this class. Please read and review the Handbook in its entirety before submitting this form. I can't wait to see you on Wednesday, April 11th from 7PM - 8:30PM! - Gabrielle Ott

Email *

1. Student Name, Nickname (If Any), Age, DOB *

Primary Contact Phone Number *

Emergency Contact Name, Phone Number *

Home Address *

Release Statement

YYYY

Release Statement Electronic Agreement *

By selecting this checkbox, I have read, understand and agree to the above Release Statement.

Required

Waiver

YYYY

Waiver Electronic Agreement *

By selecting this checkbox, I have read, understand and agree to the above Waiver.

Required

Handbook and Registration Electronic Agreement *

By selecting this checkbox, I have read, understand and agree to all terms and conditions listed in the Handbook and Student Registration Form.

Required

I understand that I must read and review the Island Shakedown Handbook, complete this online Island Shakedown Registration Form and pay the one-time tuition fee of $100 using one of the payment methods listed in the Handbook in order to complete my enrollment for this class. I also understand that this class is for women ages 18 and older, and that I meet the age requirement in order to participate. *

Yes, I understand and agree to the above as described.

Required

Student Name (Considered As Electronic Signature) *

Referred By:

A copy of your responses will be emailed to the address you provided.

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