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2020 Fall Program Adult Registration Form

Student Information and Waiver

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Optional: Student is MaleFemaleOtherWould rather not say

Mailing Address




Please list ANY medical considerations (if not applicable, write "none"

List previous experience in dance / music / theater

Emergency Contact Information





Please choose one or more programs from the list below you would like to sign up for.

COMMUNITY CLASSES FOR TEENS AND ADULTS
If you already own a class pass, you
can use it to pay for Community Classes, but we ask you to commit for the whole session
(7 classes) unless differently listed.

BALLET on Zoom, ages 11-adults, with Fiona Scruggs, Monday, 6:30-7:45PM (included in $50 4 class pass)BALLET in-studio, ages 11-adults, with Fiona Scruggs, Monday, 6:30-7:45PM, ongoing (included in $50 4 class pass)*BALLET on Zoom, ages 11-adults, with Fiona Scruggs, Saturday, 10:30 AM-12 PM (included in $50 4 class pass)BALLET in-studio, ages 11-adults, with Fiona Scruggs, Saturday, 10:30 AM-12 PM, ongoing (included in $50 4 class pass)*MODERN, ages 14-adults, Open level, Beginner +, with Bettina Montano, Tuesday, 9-10 AM, Oct.6-Nov.17 ($88 for the session)MODERN, ages 14-adults, Open level, Beginner +, with Bettina Montano, Friday, 6-7 PM, Oct.9-Nov.20 ($88 for the session)MODERN INTERMEDIATE/ADVANCED, ages 16-adults, with Bettina Montano, Monday, 6-7:30 PM, Oct.12-Nov.23 ($88 for the session)MODERN/JAZZ, Advanced Beginner/Intermediate level, ages 13-adults, with Bettina Montano, Thursday, 6-7:15 PM, Oct.8-Nov.19 ($88 for the session)Modern with Laura Coe, Open level, Ages 13+, Wednesday 4:15-5:30PM October 14-Nov 18 ($75 for the session or access with class pass)CONTEMPORARY, age 18+, Intermediate/Advanced, with Isadora Wolfe and Joe Poulson, Wednesday, 6-7:30 PM, Oct.7-Nov.18 ($88 for the session)TAP INTERMEDIATE, for ages 11-adult, with Tom Masters, Friday, 5:30-6:30PM Oct.9-Nov.20 ($112 for the session)TAP INTERMEDIATE/ADVANCED, for ages 12-adults, with Tom Masters, Saturday, 4:30-5:30 PM, Oct.10-Nov.21 ($112 for the session)YOGA with Erin Naylor, Saturday, 9-10 AM, Oct.10-Nov.21 (included in $50 4 class pass)*YOGA with Erin Naylor, Wednesday, 6-7 PM, Oct.7-Nov.19 (included in $50 4 class pass)*TAI CHI with Kathy and David Crowe, Mondays 6:30-8PM Contact greatchi@berkshiretaichi.com for information and registration.TAI CHI with Kathy and David Crowe, Fridays 9:30-11AM Contact greatchi@berkshiretaichi.com for information and registration.FLAMENCO, for ages 12-adult, Beginner +, with Joanne Bockemuehl-Jackson, Tuesday, 6-7 PM, Oct.6-Nov.17 ($88 for the session)


*Limited spots: please email/call to reserve your spot.

Payment Method: PayPal,check

Waiver

  • have read and been informed about the content and requirements in the Berkshire Pulse Policies and Information and agree to abide by these guidelines as a condition of my and/or my child’s enrollment at Berkshire Pulse.
  • I am aware that all recreational activities entail some risk of physical injury and illness and I certify that I have discussed any pertinent information concerning any medical history or any limitations I may have with a representative of Berkshire Pulse, Inc. I hereby agree to assume all reasonable risk associated with participation in any programs held by Berkshire Pulse, Inc. and hereby release Berkshire Pulse, Inc. and any of their agents, employees, representatives, successors, or assigns from any damages, liability, actions, causes of injury, or property damage sustained by me, my family or guests, or by other members, guests, or employees if such an injury or property damage is caused in whole or in part by me, my family, or guests.

Check one:
I giveI do not give

Berkshire Pulse, Inc. permission to use photographs and/or videos in which I appear for any
fundraising and/or marketing purposes that Berkshire Pulse, Inc. deems appropriate.

Please use your finger or mouse to sign in space below.

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