Na'ama Rose Belly Dance
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Online Registration Form
To register for classes/workshops, please complete this form and click the Submit button at the bottom of this page.
Registration is not complete until payment has been received. Payment can be made under "Classes".
Register ASAP to reserve your spot in class.
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Name of Student
Birth Date (mm/dd/yyyy)
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Parent's name if student is under 18 years
Include Parent's name if student is under age 18.
Street Address, City, State, and Zip Code
How did you hear about Na'ama Rose Dance
Belly Dance Level I, Mondays, 6:30-7:30pm (8 wks)
Belly Dance Level II, Mondays, 7:45-8:45pm (8 wks)
Yoga Level I - II, Sundays, 9:45-10:45am (8 wks)
Mondays, 7:30-8:30pm (8 wks)
Payment Method - Registration is not complete until payment has been received.
Cash (in person only)
Payment is due in full on or before the first day of class. Registration is not complete until payment has been received. Registration is on a first come first serve basis. Class size is limited. Checks are payable to Bodyscapes, Inc. There are no refunds granted unless a class is cancelled. For checks that are retuned for insufficient funds, a charge of $25 will be assessed. Missed classes can not be made up in subsequent sessions. No exceptions. Classes begin on time.
Signature and Waiver
By checking this box I certify that the above named student is in good health and capable of participating in classes. I hereby release Na'ama Rose Dance and Bodyscapes and their representatives from all liability for personal injury, illness, or property loss or damage. I agree to allow Na'ama Rose Dance to take photographs of me or my class for studio promotional use (names will be withheld).
Room to Move Studio
3725 Chicago Rd.
Steger, IL 60475
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