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Next Event: December 31 (Wednesday) at      |     More Details...   Register Now!

Registration   Regular Price Early Bird Discount (before December 31, 1969) Group Discount (2 or more people) Student Price Please fill out the following form in order to register. Once you submit the form, you will be able to pay for the retreat, either using a credit card or via a PayPal account. The registration process is not complete and your spot in the retreat is not guaranteed until you make a payment. We will send you a confirmation of your reservation by email within 1 business day. * - required fields Personal Information Full Name: * Sex: *  Female    Male Birth Date: * MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDate12345678910111213141516171819202122232425262728293031Year1992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941 Address Line 1: * Address Line 2: Phone Number: * E-mail: * Total number of people in your party: * Myself23456789101112131415 Number of students in your party: 0123456789101112131415 How did you find us: Liability Waiver By making this reservation, I acknowledge that I have read and accept the liability waiver. I acknowledge that participation in events offered by Dance to Wellness may require exercise, dance movements, physical activity, and other activities involving hazards and risks of injury and that our staff may use hands-on physical contact with the student for proposes of correction. I assume all risks of injury, harm or damage arising from or related to my participation in a Dance to Wellness event. I release Dance to Wellness and its instructors, staff, agents, employees, officers, and trustees from any and all liability of any kind and nature whatsoever which may arise out of or in connection with my participation in a Dance to Wellness event. This assumption of risk and release is binding upon me and my heirs, executors, administrators, assigns and family members. Past Events November 21, 2008 - November 23, 2008 at Whidbey Island June 6, 2008 - June 8, 2008 at Whidbey Island April 11, 2008 - April 13, 2008 at Whidbey Island February 22, 2008 - February 24, 2008 at Whidbey Island November 16, 2007 - November 18, 2007 at Whidbey Island October 5, 2007 - October 7, 2007 at Whidbey Island August 18, 2007 at 62 Marion June 8, 2007 - June 10, 2007 at Whidbey Island

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