The information you disclose on this form will remain private and will not be shared with anybody except in a health/medical emergency that may result from your participation in a Nia class. Its intended purpose is to provide valuable information to your Nia teacher so that they may give the best care to you in an emergency.
eg. Jane Blogs - Mother
Cellphone is preferred.
Marketing & Communications
To the best of my knowledge the information I have provided on this form is accurate. My participation in Nia classes is voluntary and I declare myself and myself only to be responsible for my own health and safety while participating in Nia classes. I release my Nia teacher, from any responsibility for any consequences that may arise from my participation in Nia classes. *
By choosing 'Yes, I agree' below, you acknowledge that you understand the above and are in agreement and will act as your signature to the waiver.
A special request from me!
Please note that by filling out this field, you give consent to Nia in Waikato to use your testimonial (and name and age) in future marketing and promotional material. If you do not give consent, but just want to comment and give us some love, please say so by starting your statement with "for your eyes only!"
Thank you for your time!
Please check your email (and junkmail) for a message via mail-chimp. Please confirm your subscription to our newsletter so that you don't miss out on any exciting Nia get happenings around the waikato!
Also, please add our address: email@example.com to your contacts so you never miss a message from us!
Have a great day and see you on the dance floor soon.
Nik & Alex x