Contact Us

EMAIL - hayatidance@yahoo.com

TEL - 716-400-4764

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Forms and Waivers

COVID-19 Waiver and Attestation

Required for In Person classes, Waiver only for Online

To book an individual or small session online instruction or a performance, please contact me below to check availability and pricing.

Pricing for individual 1 hr Instructional Session is $50.00. Pricing for 1 hr semi-private (2-3 students) is $60 to be split by the participants.

Pricing for events varies based on duration of the performance, type of event, travel time to the event and special requests (props, specific songs, etc).

Covid-19 Health Attestation

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death.

First Name

Last Name

Initials

Date

I declare that the info I’ve provided is accurate & complete

I hereby declare that I:

1. Am willing and able to wear a mask AND maintain 6 feet distance from other class participants.

2. Have NOT been in contact with individuals not within my immediate household/quarantine bubble without wearing a mask within the past 2 weeks.

3. Am NOT experiencing any of the following COVID - 19 related symptoms: Shortness of breath, cough, fever, chills, muscle pain, headache, sore throat, loss of taste or smell.

4. Am NOT living with or caring for an individual who is a suspected or confirmed case of COVID - 19.

5. Have NOT been in contact with anyone known or suspected to have COVID - 19 in the last 14 days (even if wearing a mask).

6. Have NOT tested positive for COVID-19.

In order to minimize risk to myself and others I hereby attest that I will not attend class and will forfeit any unused portion of my class fee if I am no longer able to attest to the declaration above:

Thank you for your Class registration!

Gym Health Waiver

To register to dance classes as a new student please fill out the following medical form:

Hayatidance cannot prevent you from becoming exposed to, contracting, or spreading COVID-19 while utilizing Hayatidance’s services or premises in person. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize Hayatidance’s services and/or enter onto Hayatidance’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

I realize that participation in dance classes in person or online can involve personal injury.

ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize Hayatidance’s services and enter Hayatidance’s premises. These services are of such value to me, that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Hayatidance’s services and premises in person rather than arranging for an alternative method of enjoying the same services virtually (e.g. Zoom class/performance).

By signing this form I also assume all risks related to to use of spaces and services provided by Hayatidance either virtually or in person. I agree to not hold Hayatidance liable for any personal injury or property damage that may occur before, during or after calss.

First Name

Email Address

Last Name

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Hayati is a Certified Belly Dance instructor offering Online

and Socially Distant Outdoors Classes and Performances in Buffalo, NY

Contact Us

Forms and Waivers

COVID-19 Waiver and Attestation

Required for In Person classes, Waiver only for Online

To book an individual or small session online instruction or a performance, please contact me below to check availability and pricing.

Pricing for individual 1 hr Instructional Session is $50.00. Pricing for 1 hr semi-private (2-3 students) is $60 to be split by the participants.

Pricing for events varies based on duration of the performance, type of event, travel time to the event and special requests (props, specific songs, etc).

Covid-19 Health Attestation

Gym Health Waiver

﻿Contact Us

Forms and Waivers

COVID-19 Waiver and Attestation

Required for In Person classes, Waiver only for Online

To book an individual or small session online instruction or a performance, please contact me below to check availability and pricing.

​

Pricing for individual 1 hr Instructional Session is $50.00. Pricing for 1 hr semi-private (2-3 students) is $60 to be split by the participants.

​

Pricing for events varies based on duration of the performance, type of event, travel time to the event and special requests (props, specific songs, etc).

Covid-19 Health Attestation

Gym Health Waiver

Contact Us