

| BELLY DANCE FOR ADULTS 8 WEEK COURSE Starts August 18th Get Ready & Shape Up ! |
| 8 WEEK BELLY DANCE FOR ADULTS Get ready & shape up for Fall!!! Wednesdays, August 18th - October 6th 7:15 - 8:15 p.m. $80.00/SESSION Please wear comfortable clothes and bring a water bottle. Please send the following form with payment by August 15th to: The Medway Dance Authority P.O. Box 150 Medway, Ma 02053 Name _______________________________________ Address______________________________________ Phone____________________ Cell________________ Email________________________________________ Please enclose payment with form - Thank You! Risk of Injury Waiver I, ______________________________________, will participate in Belly Dance. I understand that as with any form of exercise or physical activity there is risk of injury. I will not hold The Medway Dance Authority or it’s representatives responsible for any injury during this program. Signature _________________________ Printed Name ______________________ Date _____________ |