School at Peridance Workshop and Intensive Registration Form

School at Peridance Workshop and Intensive Registration Form

Please select your child's current age*

4-6 years6-8 years8-12 years13-17 years

We do not currently have a workshop for your child's age group.

iReP Workshop Dates:

9/23, 10/7, 11/18, 1/13, 1/27*

*iReP Street Crew Spring 2024 Audition

Note: dancers are encouraged, but not required to attend all workshop dates. You will be able to select your workshop dates at the end of the form.

Dancers interested in participating in iReP are required to attend the audition on 1/27.
Please select the workshop your child will be attending*

iReP Fall 2023 Workshop (Ages 8-12 years, 9:00 - 10:00 am)iReP Fall 2023 Workshop (Ages 13-17 years, 12:30 - 1:30 pm)

Is your child currently attending the School at Peridance (enrolled in a class for fall semester 2023)?*

YesNo
If your child is not a current School at Peridance student, how did you hear about our workshops?

Student Information
Child's Name*

First NameLast Name
Child's DOB (MM/DD/YYYY)*
Child's preferred pronouns*

She/her/hersHe/him/hisThey/them/theirsOther
Please note any allergies or special needs that should be communicated to your child's instructor.*

Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.

Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.

LIABILITY WAIVER: I/we realize that participation in dance classes and activities could involve some possible personal injury or bodily harm. Despite precautions, accidents and injuries may occur. By signing this release form, I/we (the dancer and parent/guardian) assume all risks related to the use of any and all spaces used by Peridance Center, LLC I/we agree to release and hold harmless Peridance Center, LLC including its teachers, dancers, staff members, and facilities used by both entities from any cause of action, claims, or demands now and in the future. I/we will not hold Peridance Center, LLC liable for any personal injury or any personal property damage, which may occur on the premises before, during or after classes. Furthermore, I/we agree to obey the class and facility rules and take full responsibility for my/our behavior in addition to any damage I/we may cause to the facilities utilized by Peridance Center, LLC. In the event that I/we should observe any unsafe conduct or conditions before, during or after my/our classes, I/we agree to report the unsafe conduct or conditions to the School Director, School Coordinator, instructor or staff member as soon as possible. By submitting this form, you also give consent for your child to be photographed during School at Peridance activities. These photos are for the sole use of Peridance for promotion and display and not for any commercial purpose. I accept and acknowledge the above terms and conditions and agree to them as a Parent / Guardian on behalf of my child / children. Please note that all sales are final and there are NO REFUNDS once registrations are processed and paid. By signing below, I acknowledge that I have read and agree to the terms above.
By signing below, I acknowledge that I have read and agree to the terms above. *

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Workshop & Audition Information

Students are encouraged, but not required, to attend all workshop days! Students interested in joinin iReP are required to attend the audition on 1/27. Acceptance to iReP is by audition only.

Ages 8 - 12 years will meet from 9:00 - 10:00 am

Ages 13 - 17 years will meet from 12:30 - 1:30 pm

Please select the dates your child will be attending below.*

Saturday, January 27thiReP Audition for Spring 2024

$25.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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School at Peridance Workshop and Intensive Registration Form

Student Information

Parent/Guardian Information

Emergency Contact Information