logo

2020 Summer Program Youth Registration Form

Student Information and Waiver

(PDF link)





Optional: Student is MaleFemaleOtherWould rather not say

Check if Emergency Contact

Mailing Address







Check if Emergency Contact

Mailing Address

Same as Guardian 1 Check if same as Guardian 1







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.

YOUTH PERFORMING ARTS PROGRAMS

JAZZ 2, for ages 11+ with Tom Masters at Chesterwood - June 6, July 1, 6 & 8, 4-5:30PM ($60)DANCE EXPRESSIONS, for ages 11+ with Kristine Waterman at Chesterwood - July 13, 15, 20 & 22, 4-5:30PM ($60)MODERN, for ages 11+ with Bettina Montano at Chesterwood - July 2, 9 & 16, 4-5:15PM ($45)BROADWAY JAZZ, for int./adv. level dancersages 13+ at The Mount - June 25, July 2, 9 & 16, 5:30-7PM ($60)BALLET 2, for ages 11+ with Micheline Weiler on ZOOM - June 30, July 7, 14 & 21, 4-5:30PM ($60)PROGRESS BALLET TECHNIQUE, for int./adv. level dancers ages 14+ with Micheline - Weiler on ZOOM - June 26, July 3, 10, 17 & 24, 4-5:30PM ($75)INTENSIVE, for int./adv. Dancers ages 14+ with Fern Katz and Tom Truss - Week of June 22-27, 9:30AM-12:45PM ($240)DANCE EXPRESSIONS 1, for ages 7-9 with Kristine Waterman, at Chesterwood July 6, 13, 20, 27, 2:00-3:30PM ($60)BEGINNER TAP, for ages 7-9, with Kristine Waterman, outside at Berkshire Pulse July 7, 14, 21 & 28, 4:30-5:30PM ($60)CREATIVE DANCE, for ages 4-6, with Kristine Waterman, on ZOOM July 7, 14, 21, 28 - 9:00-10:00AM ($60)

COMMUNITY CLASSES FOR ADULTS AND TEENS
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 6:00-7:305PMTAP 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 SPACES for adults and teens ages 14+

IMPROV AND CREATE with dancer/choreographer Veronica Bone - At Chesterwood, July 12, 1-4PM ($30)STRUCTURE INSPIRES 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 members/choreographer Moscelyne - ParkHarrison and Sean Lammer - At Chesterwood, August 10, 1-4PM ($30)

Please choose payment method:
PayPalCheck

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 and/or my child’s 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 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.

Choose 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.

(PDF link)