Summer Classes Registration Form
Email *
Class Schedule
Which classes/workshops would you like to attend? *
Have you been vaccinated for Covid-19, required for Brazilian Rhythm and Movement class
Clear selection
First Name and Last Name *
Street address
City, State, Zip Code
Parent/Guardian’s first name, last name, and email if you’re under 18 years old
Phone Number
If you are a student, what school do you go to and what grade are you in?
How did you hear about the workshops?
Liability Waiver
Please consult your physician before starting any physical or exercise program. I, [STUDENT/GUARDIAN OF THE STUDENT], am in good physical condition and I understand that I am advised to adjust my participation as needed based on my abilities and stop if I experience noticeable pain or discomfort or shortness of breath. I will alert my instructor of any special needs or injuries that might affect my safety and security during class. I affirm that I alone am responsible for my decision to participate, and that by acknowledging below; I release Gateway Dance Theatre, and its instructors/partners of any liabilities for my health and safety while participating in classes at Gateway Dance Theatre. Additionally, I authorize GDT to photograph me/or my child, for photographs for use in publications and/or media presentations. If applicable, I authorize members of the media to photograph or video/film/my youth or me engaged in this workshop. I also authorize GDT and/or contracted researchers of GDT to involve my youth in outcomes measurement/evaluation of GDT programs. I understand that any data or information obtained from these activities will be treated with utmost confidentiality and my youth will not be individually identified as a participant. *
Thank you! We’ll see you at class!
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Gateway Dance Theatre. Report Abuse