Information ABOUT lo salsera / el salsero:   ( PLEASE FILL ALL THE INFORMATION)

Family Name :

Name :

Address :

City :

Cantley Chelsea Gatineau L'Ange-Gardien Ottawa Val-des-Monts

Province :

Québec Ontario

Postal Code :

Telephone :

( ) (Home)

( ) (Other)

Email :

Profession / Trade :

What age group do you belong to? 19 or less 20-29 30-39 40-49 50-59 60+

REGISTRATION FOR WHICH DANCE COURSE ?

Group dance courses currently scheduled : (Please click in the checkbox to select course) 

	Salsa Discovery : Beginner
	Salsa Exploration : Advanced Beginner
	Salsa 2 : Pre-Intermediate
	Salsa 3 : Intermediate
	Couple’s Package
	GoSalsa VIP Package

Private & Semi-Private courses available : (Please contact us to book an appointment)

               Private One-on-One Course

Courses not currently scheduled : (Please contact us for more information)

                Salsa 4 : Advanced Intermediate

Which of these other specialty courses would you be interested in ? (Please note that courses will be available based on demand)

               GoSalsa Choreography

TRAINING

Have you taken Salsa dance classes previously?           YES            NO  

If yes, what level ?     Beginner Intermediate Advanced

NOTE : Please kindly arrive at least 15 minutes before the starting time of your class. Thank you for your understanding. Gracias amigos!

ADVERTISING

Where did you see or hear about the Ad concerning our dance classes?

In a published "Revue de Gatineau" / "Le Régional"

On the radio   Television

"Super Aubaines" Magazine

Restaurant Pamphlet (which one?)  

Self-detacheable display (specify where?)  

GoSalsa Web Site

Referral

Facebook Ad    Google Ad    Canada Post Ad

GoSalsa events (where?)  

Social events (where?)  

Others, (specify)  

DISCLAIMER/POLICY

SORRY : All courses are non-refundable. You can makeup for a missed class in the following scheduled session. Thank you for your understanding.

NON-responsibility Clause and Signature

GoSalsa, its instructors and /or administrators are not responsible, under any circumstances, in case of bodily damage, loss or other damage to the person or the establishment including negligence during the courses, practices and/or special events. This applies to the students, professors and spectators.

The students accept to participate in the course at his or her own risks and renounce himself or herself and its beneficiaries to all claims of any nature and to pursue any intended damages against GoSalsa, its instructors and/or its administrators or any damage suffered at the occasion of the activities he or she participates.

Signature

Date