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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

BODYSONNET September 3, 6-7:30PM ($20)*FERN KATZ September 9, 5:30-7:00PM ($20)*ISADORA WOLFE and JOE POULSON September 16, 5:30-7PM ($20)* * $20 per class or $45 for the seriesBALLET, for adults and youth ages 11+ with Fiona Scruggs, Monday, 6:30-7:45PM, ongoing & Saturday, 10:30-11:45AM, ongoing on ZOOM (included in $50 4 class pass)BALLET, for adults and youth ages 11+ with Fiona Scruggs, Monday, 6:30-7:45PM, ongoing & Saturday, 10:30-11:45AM, at Pulse (included in $50 4 class pass) - limit of 6 studentsINTERMEDIATE MODERN for adults and teens ages 14+ with Bettina Montano & Guests, Monday, September 14, 21 & 28, 5:30-7:00 PM at Chesterwood (included in $50 4 class pass)MODERN/JAZZ, for adults and teens, ages 14+, Open level, advanced beginner-intermediate with Bettina Montano, Thursday, September 10, 17 & 24, 5:30-7:00 PM at Chesterwood (included in $50 4 class pass)TAP, for ages 12-adult Intermediate/Advanced with Tom Masters, Friday, September 11, 18, 25 & October 2, 5:30-6:30PM outside at Pulse ($60)YOGA OUTDOORS with Erin Naylor, Saturday, September 12, 19 & 26, 9:00-10:00AM at Chesterwood (included in $50 4 class pass)TAI CHI with Kathy and David Crowe, Mondays 6:30-8PM and Fridays 9:30-11AM. Contact greatchi@berkshiretaichi.com for information and registration.CAPOEIRA, ages 11-adult with Tarcisio Ramos dos Santos, Wednesday, September 9, 16, 23 & 30 at Chesterwood ($60)INTRO TO FLAMENCO, for ages 12-adult with Joanne Bockemuehl-Jackson, Tuesday, September 8, 15, 22 & 29, 6:00-7:00 PM outside at Pulse ($60)DRUMMING CIRCLE, for ages 12-adult with Rick Schrum, Saturday, September 12, 19 & 26, 10:15-11:00 AM at Chesterwood ($45)RHYTHM DANCE FUSION, for ages 12-adult with Kim Waterman, Saturday, September 12, 19 & 26, 11:15 AM-12:15 PM at Chesterwood ($45)


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Waiver

  • I have read and been informed about the content and requirements in the Berkshire Pulse and Chesterwood 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:
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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.

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