Summer Dance Workshop 2023 Registration

Step 1 of 3

Thank you for using the DW SDW 2023 Registration & Scholarship application online form. Completed student registration forms are due on or before June 26. The program is Monday-Friday June 26-30, 2023 at 10:00am-3:00pm daily. A culminating in-studio showcase performance for participants’ friends and family will take place at 2:00-3:00pm on Friday, June 30, 2023.

This form will collect student personal identification and contact information; liability and media releases; program selection & payment options; and scholarship application information. For any questions regarding registration, contact the Director of Education at school@dancingwheels.org or call (216) 432-0306 ext. 204.

Student Information

Name(Required)

First Last

Pronouns

What pronouns or names do you use?

Date of Birth(Required)

Age

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student is below 18 years of age(Required)

Yes

Parent/Guardian Name(Required)

First Last

Parent/Guardian Phone(Required)

Parent/Guardian Email(Required)

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Accessibility Needs

Do you require any accessibility needs? Is there anything you would like us to know about you or your disability?

Liability Waiver

I, being aware of my own/my student’s health and physical condition, and having knowledge that my/my student’s participation in any physical activity may be injurious, am acknowledging this release from liability for accidental injury or illness to me/my student or my property/my student's property which may be incurred as a result of participating in this physical activity. I hereby assume all risks connected therewith and consent to my/my student’s participation in this program. In the event that medical care or treatment is required, I agree to be financially responsible for any costs incurred as a result. I acknowledge that I have carefully read this Liability Waiver and Release Form and fully understand that it is a release of liability. I agree to give up any right that I may otherwise have to bring a legal action against the Dancing Wheels Company & School and its affiliates for negligence or any other personal injury, illness, or property damage.

Release of Liability(Required)

I hereby agree to the above Release of Liability for the Dancing Wheels Company & School.

Media Release

I hereby grant permission to the Dancing Wheels Company & School to use photographs and/or video of me taken at all Dancing Wheels Company & School classes, performances, and events in publications, news releases, online, and in other communications related to the mission of the organization. I understand that my image may be used in photographs and video recordings and that these media will remain the property of the Dancing Wheels Company & School henceforth. The Dancing Wheels Company & School may then use these images at any future time as they deem appropriate in providing future promotional materials.

Media Release Agreement(Required)

I hereby agree to the above Media Release for the Dancing Wheels Company & School.

I do not release my/my student's image for use by the Dancing Wheels Company & School.

Program and Payment Method Selection

Select your payment option amount below. Payments can be made via PayPal upon submission of this form. Payments by check or cash are also accepted in person at Dancing Wheels. Upon form submission, you will be redirected to PayPal if you enter a payment amount in the custom payment field. If you choose to not make a payment at the time of registration, then simply submit the form upon completion and the Director of Education will contact you regarding your due tuition and payment options.

Calculating Tuition

$300 Full Tuition (due by June 26, 2023)

Drop-in Rate = $15/class

Registration type(Required)

DW SDW 2023 M-F 10am-3pm $300

My $50.00 non-refundable deposit holds my place if received by June 15, 2023.

Drop-in class rate $15.00

Payment Method:(Required)

Cash

Check (payable to Professional Flair Inc.)

Credit/Debit Card

DW Summer Dance Workshop 2023 Registration

Student Information

Liability Waiver

Media Release

Program and Payment Method Selection

Calculating Tuition