Zumbatomic® and the Zumba Fitness logo are trademarks of Zumba Fitness, LLC, used under license.

Zumbatomic® For Kids Fitness Classes - Registration Form

Instructions:

Parent of legal guardian to fill-out and sign registration, and liability waiver forms.

The Mahogany HOA will provide a copy to the instructor the first day of class.

Class Location: Mahogany West Beach – Basketball Court

Time: Wednesday 6:00 to 7:00 pm

Class Dates are:

June 26; July 3, 10, 17 (no classes July 24 and 31);

August 7, 14, 21 and 28

*A total of 8 classes will run Wednesdays as noted above for Mahogany members and guests only*

Cost: Members - $54.00 + GST & Member Guests - $60 + GST for pre-registered 8 class session.

Minimum Class Size: 10 Maximum Class Size: 30 Age: 6 to 12 only

Registration: at the Mahogany Information Centre – 6 Mahogany Terrace, Monday to Thursday ONLY from

2 to 8 pm.

Payment method: Debit only, payable at the time of registration

Registration Deadline is June 20, 2013.

Members may register guests as long as the member is attending the classes with their child and guest.

Child to bring a water bottle and snack for break as well as favourite accessories (see website program

details).

Classes will be held at the Marquis de Lorne Community Centre, 6 Copperstone Way SE, the same day and

time following notification from the Instructor due to weather related concerns only.

Cancellation refunds are only applicable if the class is cancelled by the instructor for other than weather

related reasons, a make up class cannot be scheduled and the Programs committee notified of the cancellation

in writing.

For more information on registration please contact lknight@mahoganyhoa.com; or for class detail contact

the instructor Maria Pedrosa directly: 403-802-4742 or tropicart.brazil@gmail.com.

Maria Pedrosa

Licensed Instructor/ZIN Member-Zumba B1 & B2, Zumbatomic

403-542-0051 - tropicart.brazil@gmail.com – www.zumba.com

Full Name of Child:

Date of Birth:

Emergency Contact (name/relationship/phone):

Home Phone: Parent / Guardian Cell Phone:

Address:

Parent / Guardian E-mail (will be kept confidential):

Zumbatomic® and the Zumba Fitness logo are trademarks of Zumba Fitness, LLC, used under license.

Liability Waiver Release Form

Informed Consent and Liability Waiver Release for Participants in Zumbatomic® Fitness Classes conducted by

Maria Pedrosa

I agree and consent to the following :

I am voluntarily participating in the Zumbatomic® Fitness classes conducted by Maria Pedrosa. I recognize that the program

requires physical exertions that may be strenuous at times and may cause physical injury and I am fully aware of these risks

and hazards involved.

I understand that it is my responsibility to consult with a physician prior to and regarding participation in the above-

mentioned program. I represent and warrant that I have no medical condition that would prevent participation in the program.

I agree to assume full responsibility for any risks, injuries or damage known or unknown which I might incur as a result of

participating in the Zumbatomic® Fitness program.

I knowingly, voluntarily, and expressly waive any claim I may have against Maria Pedrosa or the Mahogany Homeowners

Association for injury or damages that I may sustain as a result of participating in the Zumbatomic® Fitness program/class.

I, my heirs, or representatives forever release, waive, discharge, and covenant not to sue Maria Pedrosa or the Mahogany

Homeowners for any injuries or death caused by their negligence or other acts.

I have read the above waiver and release of liability and fully understand its contents. I voluntarily agree to the terms

and conditions stated above.

__________________________ ___________________________

Signature of Participant Date

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Note: If the participant is not 18 years of age or older, he/she must have the consent of a parent or guardian who will also

read, understand and agree to the above terms. The Parent or Guardian must then sign and assume responsibility for the

above terms.

I ______________________________, as parent or legal guardian of the above participant, hereby understand, agree

to, and assume responsibility for the above terms.

_________________________________ ____________________________

Signature of parent or legal guardian Date

E-mail address: _________________________________

(please print)