Name *
Name
Have you participated in a Nia with Nik Nia Class or Event (Play!Shop/Workshop) before? *
If you do not have a mobile please answer n/a here.
Emergency Details
Emergency Contact Name
Emergency Contact Name
Mobile number is preferred
Medical History
Please let me know about any past or current injuries or medical conditions, including medication you are currently on and anything else that may affect your Nia experience. All information will be kept in strict confidence.
Marketing
How did you hear about the event?
Waiver Section
This section must be filled out by all participants
Waiver agreement *
I understand that this event/workshop is undertaken at my own risk and I hold no one liable, but myself for any injury, damage or loss that that may occur while participating.
Film & Photography agreement *
I understand that there may be film and/or photography of the event and I consent to having my image used for free as part of any promotional material developed by Nia with Nik/Nia in Waikato.
I wish to be added to the Nia Newsletter, so I can keep updated on Nia events and other happenings! *
I understand that I can opt out of this at any time. A message from me: I'd hate for you to miss out on future happenings, so please look in your inbox and CONFIRM your subscription via mailchimp - it might be in your junkmail! Aroha Nik
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