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2020 Winter 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






***IMPORTANT*** With the most recent rise in positive COVID-19 cases in the Berkshires, it’s fundamental that we all continue to adhere to the CDC and State guidelines on social distancing, hand hygiene and wearing a mask. We are monitoring the evolving situation closely. If at any time in the coming weeks we decide that it is no longer safe to conduct in-person classes, some of our classes will go remote (either live or with pre-recorded classes) and some classes will pause and credit will be assigned for these classes when they resume in the Spring, or once it’s safe to be back in the studio.

When registering, please make sure you note if the class(es) will go remote or will pause.

Thank you for your support in this process.

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.

BALLET ON ZOOM, ages 11-adults, with Fiona Scruggs, Monday, 6:30-7:45PM (included in $50 4 class pass) - WILL CONTINUE REMOTEBALLET in-studio, ages 12-adults, Advanced Beginner/Intermediate level with Micheline Weiler, Saturday, 10:30 AM-12 PM, ongoing (included in $50 4 class pass)* - WILL GO REMOTEMODERN, ages 14-adults, Open level, Beginner +, with Bettina Montano, Tuesday, 9-10:15 AM, ongoing (included in $50 4 class pass) - WILL GO REMOTEMODERN INTERMEDIATE/ADVANCED, ages 16-adults, with Bettina Montano, Monday, 6-7:30 PM, Dec.7-Jan.18 ( $63 for the session ) - WILL PAUSEMODERN/JAZZ, Advanced Beginner/Intermediate level, ages 13-adults, with Bettina Montano, Thursday, 6-7:15 PM, ongoing (included in $50 4 class pass)* - WILL PAUSEMODERN, ages 13+, Open level with Laura Coe, Wednesday 4:15-5:30PM, Dec.2-Jan.20 ($75 for the session) - WILL PAUSETAP INTERMEDIATE, for ages 11-adults, with Tom Masters, Friday, 4:30-5:30PM Dec.4-Jan.22 ($96 for the session) - WILL GO REMOTETAP INTERMEDIATE/ADVANCED, for a ges 12-adults, with Tom Masters, Saturday, 4:30-5:30 PM, Dec.5-Jan.23 ($96 for the session) - WILL GO REMOTEYOGA with Erin Naylor, Saturday, 9-10 AM, ongoing (included in $50 4 class pass) - WILL PAUSEYOGA with Erin Naylor, Wednesday, 6-7 PM, ongoing (included in $50 4 class pass) - WILL PAUSETAI CHI with Kathy and David Crowe, Monday, 6:30-8PM, ongoing Contact greatchi@berkshiretaichi.com for information and registration. - WILL GO REMOTETAI CHI with Kathy and David Crowe, Friday, 9:30-11AM, ongoing Contact greatchi@berkshiretaichi.com for information and registration. - WILL GO REMOTE


*Please email us if you are unable to come to class.

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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