I am registering:* One dancer. Two dancers. Three dancers. Four dancers. Five dancers.
First Dancer Information Student Name:*
First
Last
Address*
Household Primary Phone:*
Primary Parent or Guardian Name:*
First
Last
Is the primary the mother, father or guardian of the dancer?* Mother Father Guardian
Primary Email Address:* Will receive dance communications.
Additional Phone Number (if applicable):
Secondary Parent or Guardian Name:
First
Last
Is the secondary the mother, father or guardian of the dancer? Mother Father Guardian
Secondary Email Address: Will receive dance communications.
Secondary Phone Number:
Student's Email Address: List the student’s email address if available and if you’d like your dancer to receive dance communications.
Student Gender:* Female Male
Student Birthdate (MM/DD/YYYY):*
MM slash DD slash YYYY
Student Age:*
Medical Conditions: Does your dancer have any medical conditions that we should be aware of?
School Grade:* N/A Pre-School Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
School Attending or Homeschooled:* Key N/A if not yet in school.
Previous Dance Experience: Include type of dance, years taken and studio.
My dancer is a Performing Arts Student (competition).* No. Yes.
This field is hidden when viewing the form
First Dancer Class Selection PAC Class Options: You will be contacted if your preferred class time is full.
Which type of dance does your child wish to take?* You may select more than one class type.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Please select your preferred class time:* You will be contacted if your preferred class is full.
Second Dancer Information Student Name:*
First
Last
Student's Email Address: List the student’s email address if available and if you’d like your dancer to receive dance communications.
Student Gender:* Female Male
Student Birthdate (MM/DD/YYYY):*
MM slash DD slash YYYY
Student Age:*
Medical Conditions: Does your dancer have any medical conditions that we should be aware of?
School Grade:* N/A Pre-School Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
School Attending or Homeschooled:* Key N/A if not yet in school.
Previous Dance Experience: Include type of dance, years taken and studio.
My dancer is a Performing Arts Student (competition).* No. Yes.
This field is hidden when viewing the form
Second Dancer Class Selection PAC Class Options: As a PAC Dancer, your student will receive a separate, emailed schedule for PAC classes (class times for choreography, technique and ballet classes). Please select which classes you are enrolling in and select additional non-PAC classes, if desired (i.e. if your dancer wishes to participate in a recital hip hop class, but is not required to take that class for PAC).
Which type of dance does your child wish to take?* You may select more than one class type.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Third Dancer Information Student Name:*
First
Last
Student's Email Address: List the student’s email address if available and if you’d like your dancer to receive dance communications.
Student Gender:* Female Male
Student Birthdate (MM/DD/YYYY):*
MM slash DD slash YYYY
Student Age:*
Medical Conditions: Does your dancer have any medical conditions that we should be aware of?
School Grade:* N/A Pre-School Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
School Attending or Homeschooled:* Key N/A if not yet in school.
Previous Dance Experience: Include type of dance, years taken and studio.
My dancer is a Performing Arts Student (competition).* No. Yes.
This field is hidden when viewing the form
Third Dancer Class Selection PAC Class Options: As a PAC Dancer, your student will receive a separate, emailed schedule for PAC classes (class times for choreography, technique and ballet classes). Please select which classes you are enrolling in and select additional non-PAC classes, if desired (i.e. if your dancer wishes to participate in a recital hip hop class, but is not required to take that class for PAC).
Which type of dance does your child wish to take?* You may select more than one class type.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Fourth Dancer Information Student Name:*
First
Last
Student's Email Address: List the student’s email address if available and if you’d like your dancer to receive dance communications.
Student Gender:* Female Male
Student Birthdate (MM/DD/YYYY):*
MM slash DD slash YYYY
Student Age:*
Medical Conditions: Does your dancer have any medical conditions that we should be aware of?
School Grade:* N/A Pre-School Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
School Attending or Homeschooled:* Key N/A if not yet in school.
Previous Dance Experience: Include type of dance, years taken and studio.
My dancer is a Performing Arts Student (competition).* No. Yes.
This field is hidden when viewing the form
Fourth Dancer Class Selection PAC Class Options: As a PAC Dancer, your student will receive a separate, emailed schedule for PAC classes (class times for choreography, technique and ballet classes). Please select which classes you are enrolling in and select additional non-PAC classes, if desired (i.e. if your dancer wishes to participate in a recital hip hop class, but is not required to take that class for PAC).
Which type of dance does your child wish to take?* You may select more than one class type.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* Please select your preferred class time:
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Fifth Dancer Information Student Name:*
First
Last
Gender:* Female Male
Student's Email Address: List the student’s email address if available and if you’d like your dancer to receive dance communications.
Student Birthdate (MM/DD/YYYY):*
MM slash DD slash YYYY
Student Age:*
Medical Conditions: Does your dancer have any medical conditions that we should be aware of?
School Grade:* N/A Pre-School Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
School Attending or Homeschooled:* Key N/A if not yet in school.
Previous Dance Experience: Include type of dance, years taken and studio.
My dancer is a Performing Arts Student (competition).* No. Yes.
This field is hidden when viewing the form
Fifth Dancer Class Selection PAC Class Options: As a PAC Dancer, your student will receive a separate, emailed schedule for PAC classes (class times for choreography, technique and ballet classes). Please select which classes you are enrolling in and select additional non-PAC classes, if desired (i.e. if your dancer wishes to participate in a recital hip hop class, but is not required to take that class for PAC).
Which type of dance does your child wish to take?* You may select more than one class type.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
Please select your class time:* You will be contacted if your preferred class is full.
General Information Please list additional registration information here. Also, what would you like your dancer(s) to gain from this dance experience?
How did you find our dance center? Other Returning Student/Family Drive By Newspaper Second/Third Generation Student Social Media Word of Mouth
Will your dancer(s) be participating in the spring recital?* Yes. No. Unsure.
Releases Registering at Straub Dance Center requires each family to agree to the following releases.
General Release* I have read the Straub Dance Center (SDC) policies and agree to abide by them. I also hold SDC and SDC employees and volunteers harmless for any and all injuries arising out of participation in any class or performance at or away from the dance center.
I agree.
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19* The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing as well as strict cleaning protocols. Straub Dance Center (“SDC”) has put in place many preventative measures to reduce the spread of COVID-19; however, SDC cannot guarantee that you or your child(ren) will not become infected with COVID-19 by entering our facility. Further, attending SDC could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending SDC classes and events and that such exposure or infection may result in personal injury, illness, permanent disability and death. I understand that the risk of becoming exposed to or infected by COVID-19 at SDC may result from the actions, omissions, or negligence of myself and others, including, but not limited to, SDC employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at SDC or participation in SDC classes/programming (“Claims”). On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless SDC, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions SDC, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any SDC program, class or event.
I agree.
Photo Release* I agree to allow Straub Dance Center (SDC) the right to publish any dance photo taken by center photographers or staff members in marketing pieces and/or online. This may include images captured by local media during performances such as the Westerville parades, etc.
I agree.
Registration – Non-Refundable* By submitting this registration form, you are agreeing to pay a non-refundable registration fee for your dancer(s). This fee will be invoiced within days of registering. Your class placement will NOT be held until your registration fee is paid. Class placement is prioritized based on first registered with registration fees paid. By submitting, you agree.
I agree.
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