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2020 Fall Program Youth Registration Form

Student Information and Waiver

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


List previous experience in dance / music / theater

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

YOUTH PERFORMING ARTS PROGRAMS

CREATIVE DANCE, for ages 4-6 with Kristine Waterman, Tuesday, September 8, 15, 22 & 29, 2:30-3:15 PM at Chesterwood ($60)DANCE EXPRESSIONS 1, for ages 6-8 with Kristine Waterman, Tuesday, September 8, 15, 22 & 29, 3:30-4:30 PM at Chesterwood ($60)DANCE FOUNDATIONS, for ages 8-10 with Veronica Bone, Thursday, September 10, 17 & 24, 4:00-5:00 PM at Chesterwood ($45)MODERN 1, for ages 10+ with Susan Quinn, Monday, September 14, 21 & 28, 4:00-5:15 PM at Chesterwood ($45)MODERN 2, for ages 11-13 with Ashley Hartka, Wednesday, September 9, 16, 23 & 30 at Chesterwood ($60)BEGINNERS BALLET, for ages 8+ with Fiona Scruggs, Friday, September 11, 18, 25 & October 2, 3:35-4:45 PM at Pulse ($60) - limit of 6 studentsBALLET 1, for ages 9-12 with Fiona Scruggs, Friday, September 11, 18, 25 & October 2, 5:00-6:00PM at Pulse ($60) - limit of 6 studentsBALLET 2/PRE-POINTE, ages 11+ with Micheline Weiler, Saturday, September 12, 19, 26 & October 3, 9:00-11:00AM at Pulse ($60) - limit of 6 studentsBALLET 3-4, for ages 13+ with Isadora Wolfe, Tuesday, September 8, 15, 22 & 29, 5:30-7:30 PM and with Micheline Weiler, Saturday, September 12, 19, 26 & October 3, 12:00-2:00 PM at Pulse ($120) - limit of 6 studentsDANCE FOR BOYS, for ages 11+ with Tom Masters, Thursday, September 10, 17 & 24, 4:00-5:15 PM at Chesterwood ($45)BEGINNERS DRUMMING, for ages 8-12 with Rick Schrum, Tuesday, September 8, 15, 22 & 29, 3:30-4:15 PM at Chesterwood ($60)*DANCES OF AFRICA, for ages 9-12 with Kim Waterman, Tuesday, September 8, 15, 22 & 29, 4:30-5:30 PM at Chesterwood ($60)* * Bundle price if you sign up for both Beginners Drumming and Dances of Africa is $100.JAZZ 2, for ages 11+ with Tom Masters, Monday, September 14, 21 & 28, 4:00-5:30 PM at Chesterwood ($45)BEGINNER TAP, for ages 7-9 with Kristine Waterman, Tuesday, September 8, 15, 22 & 29, 4:45-5:45 PM outside at Pulse ($60)TAP, for ages 12+ Intermediate/Advanced with Tom Masters, Friday, September 11, 18, 25 & October 2, 5:30-6:30PM outside at Pulse ($60)

COMMUNITY CLASSES FOR ADULTS AND TEENS
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)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+ 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+ 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 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.

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