Freespace Dance Summer Festival
City, State, Zip
Emergency Contact and Phone Number
Registering for: Please choose
Full Festival Fee: $575.00 -
Weekly Fee: $250 Please specify week(s) -
Drop In Classes ($25.00) -
Check (made payable to Freespace Dance) - Mail Payment to: PO Box 43657 Upper Mtc. NJ 07043
Credit Card - Name, Credit Card #, Expiration date and CVC -
Pay Pal -Payment made via Pay Pal will incur $5.00 additional fee -
Please provide Credit Card Information:
Credit Card number
Expiration Date/CVC number
Please read and sign disclaimer: * No Refunds given after first day of classes. Freespace Dance has the right to change or cancel due to low enrollmentAs legal guardian of the above named student, I certify that he/she is physically fit to perform in all programs at Freespace Dance, is not currently under medical care, and is not receiving medication for any condition which would or may limit participation in any way, except as listed above. I do hereby give approval to allow participation in any and all activities. I assume all risks and hazards incidental to the conduct of the activities and transportation to and from activities. I understand that these risks can never be totally eliminated, even under the supervision of properly trained and qualified instructors. I do further release, absolve, indemnify and hold harmless Freespace Dance, its dancers, instructors and/or other staff members from the responsibility of any injuries sustained by any student during the course of instruction or in performance in which he or she may participate in. I hereby waive all claims against the organizers, sponsors or any supervisors appointed by them. I also waive all claims against Freespace Dance, Montclair State University and its staff.
Freespace Dance, Inc. DOES / DOES NOT (circle one) has my permission to use photos of my child, which may be used for publicity. I have read and understand this Freespace Dance Registration Form, and acknowledge receipt a copy of this
Legal Guardian's Signature:
A copy of your responses will be emailed to the address you provided.
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