Registration Form

Ongoing Classes

Iwa L'ewa African Dance with Yewande and Leslie
@ Neighborhood House
644 W. 4th St., Plainfield, NJ 07060
Class Type*:
Number of Classes*:
Payment Method*:
Full Name*:
Email*:
Address*:
City, State, Zip*:
Home Phone*:
Cell Phone:
Grade:
(Youth Applicants Only)
Name of Parent/Guardian:
(Youth Applicants Only)
Emergency Contact Name*:
Emergency Phone*:
Comments:
CLASS RELEASE & AGREEMENT

Photo / Video Release*:
I agree to give African Global Arts and Yewande Kelley-Johnson permission to use photos/videos for publicity and promotion of African Global Arts.

General Release or Parent / Guardian Permission*:

I am the above named person (or parent / guardian of youth applicant) and do hereby give approval to participate in all activities and assume all risks and hazards incidental to the conduct of the activities; and do further hereby release, absolve, and indemnify, the Neighborhood House, African Global Arts, Yewande Kelley-Johnson and the sponsors or any supervisors appointed by them.

Your Signature*:
(Please type your full name)
Today's Date*:
* required field.

African Global Arts respects your privacy and will not knowingly share your information with any third party. Your contact information will be used solely for record keeping by African Global Arts, Yewande Kelley-Johnson and staff.