Fall Classes Registration Form
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Email *
Which classes/workshops would you like to attend? *
Vaccines are required for anyone 12 and older.
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?
Age
Gender
Ethnicity
How did you hear about the classes/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.
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