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2020 Summer 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

BALLET, for adults and teens ages 11+ with Fiona Scruggs, Mondays 6:30-7:45PM and Saturdays 10:30-11:45AM on ZOOMZUMBA with Lindsey Berkowitz, Saturday 11:00AM-12:00PM on ZOOMVINYASA FLOW YOGA with Lisa Darling, Wednesdays 9-10AM on ZOOMRESTORATIVE/GENTLE YOGA with Lisa Darling, Fridays 10-11AM on ZOOMMORNING MODERN for adults and teens ages 14+ with Bettina Montano - Beginners+ at Chesterwood, Tuesdays during June 16 - July 13, 9:00-10:30AMMORNING MODERN for adults and teens ages 14+ with Bettina Montano - Int./Adv. At The Mount, Mondays during June 29 - July 20, 9:00-10:30AM (new time)MODERN/JAZZ for adults and teens ages 14+ with Bettina Montano. Open level, at Chesterwood on Thursdays 6:00-7:30PMTAP with Tom Masters. Int./Adv. Outside at Berkshire Pulse (plywood provided) on Fridays, 5:30-6:30PMWORLD MUSIC DRUMMING for adults and teens ages 13+, drumming circle led by Rick Schrum. Open level, at The Mount on Tuesdays, 5-5:45PMRHYTHM DANCE FUSION for adults and teens ages 11+ with Kim Waterman and Guests. At The Mount on Tuesdays during June 23 - July 21, 6-7PMYOGA with Erin Naylor at Chesterwood Open level, on Saturday July 11,18,25 & Aug 1, 9-10AMZUMBA with Lindsey Berkowitz at Chesterwood* Open level, on Wednesday July 8,15,22 & 29, 6-7PM

WORKSHOPS - MAKING DANCES IN OUTSIDE SPACESfor adults and teens ages 14+

IMPROV AND CREATE with dancer/choreographer Veronica Bone - At Chesterwood, July 12, 1-4PM ($30)STRUCTURE INSPIRED MOVEMENT with Tom Truss - At The Mount, 4 class session on July 8, 15, 22 & 29, 5:30-7PM ($80)TAKE SPACE with BODY SONNET Company member/choreographer Moscelyne ParkHarrison and Sean Lammer- At Chesterwood, August 10, 1-4PM ($30)

Payment Method: PayPal,check

Waiver

  • I have read and been informed about the content and requirements in the Berkshire Pulse, Chesterwood and The Mount Policies and Information and agree to abide by these guidelines as a condition of my enrollment at Berkshire Pulse.
  • I am aware that all recreational activities entail some risk of physical injury and I certify that I have discussed any pertinent information concerning any medical history or any limitations my child or 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 or my child 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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