Taylor Mill Line Dancing Classes               
               

The Taylor Mill Recreation Committee, in conjunction with the City of Taylor Mill, is offering Line Dancing Classes at the Taylor Mill Firehouse, located at 5225 Taylor Mill Road, Taylor Mill, KY, with Instructor Jeannine Teegarden. 

 

Each class will run consecutively over the same six (6) week period with all classes held on Wednesdays, beginning September 17, 2014 and ending October 22, 2014 from 6:30 pm until 7:30 pm.    

 

For those interested in participating, please print this form, complete it, and mail or drop it off to us with your payment.  Checks should be made payable to the City of Taylor Mill.

 

6 Week Session Price:  $45.00

Classes are limited so please register now!
  

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Session Attending        □ Regular Session ($45.00)

 

 

Name: _____________________________________________________________

Address:  ___________________________________________________________

Phone No:   ________________________

Email Address:  _____________________________________________________

 

Emergency Contact

Name:  ____________________________________________________________

Phone No:  _________________________________________________________

 

Must be signed to constitute valid registration.

 

In consideration of the acceptance of my registration, I for myself, my executors, administrators and assignees, do hereby release and discharge all claims against the City of Taylor Mill, personnel or private instructors of damages, demands, actions whatsoever in any matter arising out of my participation in said event.  I attest that I am physically fit and have full knowledge of the risk involved.  I also agree that qualified personnel may examine me during the class in the event that medical problems arise.  Paramedics, EMT's or qualified personnel have the right to disqualify and remove me from the event if, in their opinion, I may be suffering from a life threatening condition.  I give permission to use photographs for promotional purposes.

 

Participants Signature:  ________________________________________ Date:   __________________

 

Parent or Guardian Signature (required for anyone under 18)  ____________________________________

 

 

Please return registration form, with payment, to City of Taylor Mill - 5225 Taylor Mill Road, Taylor Mill, KY 41015.  For additional information please call 859.581.3234.  Thank you.