Registration Form

PERSONAL INFORMATION

EVENTS / WORKSHOPS

ANNIVERSARY PARTY
SELECT Saturday Mar 6
6 - 11.30 pm

BADAZZ BELLYDANZ
SELECT Mar 6
Sat 1 - 4 pm

Dance Troupe TryOuts
SELECT March 20
Saturday 12 - 4 pm

HANNAN SULTAN
SELECT Jul 17 and 18
Sat and Sun

HOLLYWOOD TO BOLLYWOOD Dance Show
SELECT Saturday June 26

MAKE UP and HAIR for dancers
SELECT May 30, June 6
Sun 9 am - 12 pm

Matsqui
SELECT

Self Defense for Women
SELECT To register call 604-315-9760

Special Entertainment
SELECT

The Instructors Training Intensive
SELECT Please send me Instructor's training information. Instructor Certification Training -Intensive
SUMMER 2010

Tribal Fusion fundamentals with BDSS Moria
SELECT postponed

WIN ONE FREE YEAR
SELECT

POLICY: Confidance Institute will only confirm all registrations upon receipt of full payment. All fees are non refundable and non-transferable for any missed lessons, courses, workshops or workouts or for any cancellations. Should Confidance Institute cancel any program, a full refund will be provided. For and in consideration of participant’s registration with Confidance Institute Inc. and being allowed to participate in classes, workshops, performances and activities, the undersigned participant or the parent(s) or legal guardian(s) of participants relinquish any and all liability for and cause of action for personal injury, property damage or wrongful death occurring to participant arising out of participation in the Institute classes, workshops, performances and activities incidental thereto, when-ever or however they occur and for such period said activities may continue, and by this agreement any such claims, rights, and causes of action that participant may have are hereby relinquished and the participant (or parent(s)/guardian(s)) does(do) so on behalf of my/our and participant’s heirs, executors, administrators and assigns. Participant and/or participant’s parent(s)/guardian(s) acknowledge, understand and assume all risks inherent participation in said activities, and understand that said activities may involve risks to participant’s person including bodily injury, partial or total disability, paralysis, and death, and damages which may arise there from and that I/we have full knowledge of said risks. These risks and dangers may be caused by the negligence of the participant or the negligence of others, including the “releasees” identified below. It is further acknowledged that there may be risks and dangers not known to us or are not reasonably foreseeable at this time. I/We agree to abide by and be bound under the rules of Confidance Institute Inc., including those instructions by the instructor or agents of Confidance Institute Inc.. Participant and/or participant’s parent(s)/guardian(s) acknowledge, understand and assume the risks, if any, arising from the conditions and use of related premises used by the Institute and acknowledges and understands that included within the scope of this waiver and release is any cause of action, arising from the performance, or failure to perform maintenance, inspection, supervision or control of said areas and for the failure to warn of dangerous conditions existing at said premises, for negligent selection of certain releasees, or negligent supervision or instruction by releasees. Participant or participant’s parent(s)/guardian(s) agree if any claim for participant’s personal injury or wrongful death is commenced against releasees, he/she shall defend, indemnify and save harmless releasees from any and all claims or causes of action by whomever of wherever made or presented for participant’s personal injuries, property damage or wrongful death. It is the purpose of this agreement to exempt, waive and relieve releasees from liability for personal injury, property damage, and wrongful death caused by negligence, including the negligence, if any, of releasees. ‘Releasees’ include the Institute, its Affiliates, instructors, event hosts, other participants, sponsors, owners and operators of the premises used to conduct any event and each of them, their officers, directors, agents and employees. Participant and/or participant’s parent(s)/guardian(s) acknowledge that they have been provided and have read the above paragraphs and have not relied upon any representations of releasees, that they are fully advised of the potential dangers of dance instruction and understand these waivers and releases are necessary to allow said dance instruction to exist in its present form. I certify that my physician has examined me and certified that I am in good physical condition and have no disease or injury that would impair my performance or physical condition in participating in the aforementioned activities of the Institute including training for and competing. (Note: For recent injury or injuries, a physician’s report must be attached to this form. My promise to indemnify: I agree to pay all costs and expenses, including attorneys’ fees and court costs, that the Institute may incur as a consequence of any legal action arising out of (1) injury, death, or damage to me; or (2) injury, death or damage to someone else as a result of my conduct. I, the participant and/or participant’s parent(s)/guardian(s) also acknowledge, and understand that all dance routines, classes, workshops and seminars materials used by Confidance Institute Inc. are protected by copyrights laws and may not be used without prior written consent from founder of Confidance Institute Inc.

Select I AGREE I understand and agree.