Youth Registration Form A

To get started, please download and bring (or send) in Youth Registration Form A , or fill out the form below for online registration.

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Optional: Student is MaleFemaleOtherWould rather not say

Riding the bus to Pulse YesNo

How did you hear about Berkshire Pulse?

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


  • I have read and been informed about the content and requirements in the Berkshire Pulse Performing Arts Program Policies and Information and Dress Code 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.
  • I 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.