Name
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First Name
Last Name
Phone
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(###)
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Email:
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Date Request? (Please provide any & all dates desired. Sundays/Holidays require an additional service booking fee: $30.00)
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You can choose any date up to 30 days from today. Please Note: Any requested dates that are More than 30 days out into the future may not be eligible to secure a booking confirmation.
Party Package Timeframe?:
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If you're booking a 1.5 hour parties at the studio, Food/Drinks Are NOT allowed.
If you're booking a 2 hrs at the studio or More -Food/Drinks ARE allowed for an additional charge of $10.00 to your package.
Desired Time frame?
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Please let us know what time you would want your party or event from start to end time (Use exact timeframes; ex. 2:00 pm - 4:00 pm)
Event Location:
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For House Calls Ony! : Provide the event location full address (Include: City, Zip and apt #) (If you are renting our studio, just skip this question) TRAVEL FEE WILL APPLY* ( In the event you change your address stated below, please be advised it may not fit the night schedule & your party may have to be cancelled or rescheduled.
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
For HOUSE CALLS/VENUE (CHOOSE A DANCE STYLE)
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We do not provide chairs for house/venue calls. Dance styles can not be combined, choose ONLY ONE
For OUR STUDIO (CHOOSE A DANCE STYLE)
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Dance styles can not be combined, choose ONLY ONE
Upgraded "Themes" (STUDIO ONLY) 2 hours or more parties only. Add $60.00 to your party package rate.
You have the option for us to "AMP" up your party even more, by UPGRADING TO A THEME! You and your guests are responsible for dressing the part for the theme you choose. We do themed drinks, themed dance and themed games, etc.. based on the theme you CHOOSE!
Whats the Occasion?
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How Many Guest are expected?
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When confirming # of guest, Please Include Yourself
Age Group?
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Dance Level?
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Did anyone refer you?
Enter full name + their email or phone # below. We want to know who told you "Kookie's Dance Den" rocks, this is your only time to submit a referral.
Health & Fitness Liability Waiver/Informed Consent Form I have voluntarily enrolled in a fitness/dance program offered through “Kookie's Dance Den”. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I have been advised that an examination by a physician should be obtained by anyone prior to commencing a fitness and/or exercise program, or initiating a substantial change in the amount of regular physical activity performed. If I have chosen not to obtain a physician’s consent prior to beginning this fitness program, I hereby agree that I am doing so solely at my own risk. I understand that it is my sole responsibility to participate in exercises that are appropriate for the current status of my health. If I have any questions or concerns about whether or not a particular activity is appropriate to my current health status, I understand it is my responsibility to ask my doctor if this activity is appropriate before I participate in such activity. I understand that this program is not medically supervised, and exercise activities are led by independent fitness instructors or other program participants who are not employees or agents of Kookies Dance Den and I will not hold them accountable or responsible for any injuries. If I am in the building, I am responsible for my own actions. I understand that the Kookies dance den may, in its sole discretion and at any time, revoke my enrollment in the dance workshops. I understand that any exercise or fitness activity involves a risk of injury, as well as abnormal changes in blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death. I am accepting such risks and volunteering to participate with full understanding of the dangers involved. In consideration of my participation in this program, I hereby waive and release Kookie's Dance Den and its successors and assigns, from any and all claims, costs, liability and expense for any injury, loss or damage whether known, anticipated or unanticipated arising from my voluntary participation and enrollment. I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM IN ITS ENTIRETY AND FULLY UNDERSTAND IT. I UNDERSTAND THAT IT CONTAINS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING CERTAIN RIGHTS I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST CLASSES WITH KOOKIE.
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I am fully aware that NO kids/children &/or NO men are allowed to be present during the duration of the class/party! (No exceptions, please relay message to your guest). (Men who are dancing/participating in the routine are allowed).
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I agree
I agree
Kookie's Dance den host classes to teach women to be sexy and confident and have a damn good time while doing it. At discretion, this class may consist of some profane/explicit language as part of the experience. If for any reason, you wish not to have profane and/or explicit language at your party. Please check off the option "No" below along with emailing your specific request to accommodate you and your guest to info@kookiesdanceden.com Thanks!!
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Any questions/comments? Please notate in the space provided below. Once this form is submitted, you will be contacted via email for follow up and further booking instructions within 48 hours. Please remember to check your emails within this time. If you have not received a response, please email us at: info@kookiesdanceden.com
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