Summer Dance Intensive '22 Registration Form

Summer Dance Intensive '22 Registration Form
Student Name *

First Name Last Name
Student Email *
example@example.com
Student Phone Number *

Area Code Phone Number
Student Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student Gender *
Student Age *
Student Birthday *

Month Day Year
Date
School Attending
school name and grade/ year

Fitted T-shirt size- Inlet Shirt included for all Full and Half Program students

	XSmall	Small	Medium	Large	XLarge	XXLarge
Child
Adult - Ladies
Adult - Mens

Dance Experience *
Parent/Guardian Name

First Name Last Name
Parent/Guardian Phone Number

Area Code Phone Number
Parent/Guardian Email
example@example.com
SDI '22 Registration options: *

Full Program (4.5 weeks) June 29- July 31, 2022 = $1,250 Half Program (2.5 weeks) June 29 -July 15, 2022 = $550 10-class card- good for the morning technique classes in Modern, Nontraditional Partnering, and Improvisation July 5-22, 2022 = $150 Single class, good for the morning technique classes in Modern, Nontraditional Partnering, and Improvisation July 5-22, 2022 = $15 Educator/Chaperone Track*- Full (4.5 weeks) June 29 - July 31, 2022 = $660 Educator/Chaperone Track*- Half(2.5 weeks) June 29 - July 15, 2022 = $360
*Educator/Chaperone Track availible by application only- to apply please send a letter of intent to info@inletdance.org or call our Office at 216-386-1547.
SDI '22 Discounts/FEES:

Super Early Bird: $75 OFF Full Program or $50 OFF Half Program Register before Feb 15, 2022 and complete payment by April 1, 2022 Early Bird: $50 OFF Full Program or $25 OFF Half Program Register before April 1, 2022 and complete payment by May 1, 2022 LAST MINUTE Registration- ANY registration or tuition payment made after June 16, 2022 will be subject to a $50 fee.
$100 Non-Refundable Deposit due with your Registration for our FULL or HALF programs, that will go towards your tuition balance. All registrations completing payment after or June 16, 2022 will be subject to the "Last Minute" fee of $50. *Late fees and $100 deposit are not required for Single class and 10-class cards.

Early Bird discounts cannot be combined with any other discount or scholarship. Payment plans are available. Contact the Inlet office (call or text 216-386-1547) for more details.

Please make checks and money orders payable to Inlet Dance Theatre. You may also make payments securly online through Paypal. You will be given this option at the end of the Registration Form.
SCHOLARSHIPS*

I already received a Scholarship to SDI 22 I would like to apply for a Scholarship I have filled out the Scholarship Application, but have not yet received a scholarship letter.
*Partial Scholarships are available and are awarded based on need and talent. To apply for a Scholarship please fill out the Scholarship Application here
How did you hear about Inlet's Summer Dance Intensive? *

Internet Facebook Friend Mailing Poster School Masterclass

Medical Information
Doctor Name

First Name Last Name
Doctor Phone #

Area Code Phone Number
Medical Insurance
Medical Insurance Policy #
Allergies: please list ALL medical, food, or environmental allergies (including animals). Dietary Restrictions & Preferences: please list all dietary restrictions you have (vegetarian, vegan, non-dairy, gluten free, etc).
Medical Conditions and Injury History (Please list ALL current and previous) *
Medications (Please List ALL medications and what they are treating) *
Emergency Contact *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
Emergency Contact Relationship to Student
Emergency Contact Relationship to Student
LIABILTY WAIVER

I understand that dance instruction requires a broad range of movements that may strain the human body. If I experience any pain or discomfort in class, I will take the appropriate measures to stop dancing or to ask support from the instructor to make appropriate adjustments. I understand that dance classes may involve both physical and verbal corrections from the instructor, delivered at times through physical touch. If I am uncomfortable with physical corrections, I will notify the instructor at the beginning of class.

I understand that there is the possibility of physical injury in dance. I understand and expressly assume all risks involved in connection with my dance instruction and training with Inlet Dance Theatre, including but not limited to risk of bodily injury occurring as a result of contact with other students, instructors, walls, equipment, floors, and other objects located in or near dance studios. I warrant that I am physically fit and able to participate in all activities involved in dance instruction and assume absolute responsibility for the risks inherent in such instruction.

I waive all claims arising out of dance instruction and training of myself at Inlet Dance Theatre whether caused by negligence or otherwise, and whether for bodily injury, property damage, or loss or otherwise, which I may have ever against Inlet Dance Theatre, Pivot Center for Art, Dance & Expression, or any other class location, its successors, and assigns, and its officers, directors, shareholders, employees, and agents, and their heirs, executors and administrators.

In the case of emergency, I recognize that the staff will contact my emergency contacts and have me transported to the nearest medical facility.
WAIVERS
Liability Waiver Signature *

Signature of participants +18 yrs or parent/guardian Clear
Photo/Video/Image Release

I hereby grant Inlet Dance Theatre the absolute and irrevocable right and unrestricted permission in respect to photographic portraits/pictures or video taken of me in which I may be included with others, to copyright the same, in Inlet Dance Theatre’s name or otherwise; to use, reuse, publish, and republish the same in whole or in part, individually or in any and all media now or hereafter known. For any purpose whatsoever, for illustration, promotion, art, editorial, advertising, and trade, or any other purpose without restriction as to alteration, and to use my name in connection therewith if Inlet Dance Theatre so chooses.

I hereby release and discharge Inlet Dance Theatre from any and all claims and demands arising out of or in connection with the use of the photographs and/or video, including without limitation any and all claims for libel or invasion of privacy.
Photo/Video/Image Release Signature

Signature of participants +18 yrs or parent/guardian Clear

Almost there!

Just one more step is needed to secure your spot at Inlet Dance Theatre's Summer Dance Intensive...

Please select a payment option below to make your $100 non-refundable deposit
(this deposit will be applied towards your final balance)
Payment Options

I will to mail a check or money order (Make checks payable to "Inlet Dance Theatre", mail to Inlet Dance Theatre, 2937 West 25th St, Suite D, Cleveland, OH 44113 I will pay the deposit online through PayPal, see link below. I will call and make my payment over the phone, subject to a 2.75% credit card processing fee (Please call the office at 216-386-1547)
If you've chosen to make a payment online, please visit Inlet's PayPal page here, and select "SDI or SDI Jr Tuition Payment" from the dropdown menu.
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Summer Dance Intensive '22 Registration Form

Medical Information