Dance On Weekly Online Class

Dance On Weekly Online Class

Drop-In Registration
September 12, 2024 - June 26, 2025

Thursdays 11:00 AM – 12:00PM ET on Zoom
Sliding scale $5 - $20 per participant

As part of our Dance On creative aging program, this online class uses the power of moving and making to cultivate connection, creativity, and greater health at all ages. Classes are led by DX artists, including the members of our Dance On OAC Cohort. Pre-registration required.

This class is for older adults, but all ages are welcome.
Class Date
Which class are you registering for?*
Are you attending Dance On for the first time in our 2024-25 season today?*

YesNo
Participant Information

Please list information for the person who will be participating in class.
Participant Name*

First NameLast Name
Participant Email*
example@example.com
Participant Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you live or work in Takoma Park? Select all that apply.

LiveWorkOut of the area
How did you hear about our program?
Dance Exchange Mailing List

Yes, subscribe me to the Dance Exchange mailing list. You can unsubscribe at any time.
Emergency Contact Information
Emergency Contact *

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Liability and Media Release

Before registering, please read the following disclaimers. By clicking "I agree", you are agreeing to the following:
LIABILITY RELEASE: I acknowledge that I have voluntarily enrolled myself in this program and assume responsibility for all risks of injuries resulting from our participation in activities with Dance Exchange. I certify that I am physically and mentally capable of participating in these activities. I hereby represent that I have informed Dance Exchange of any pertinent medical conditions that may affect participation in these activities, including but not limited to classes, rehearsals, performances, or related events. I voluntarily agree to release, discharge, and hold harmless Dance Exchange for any and all claims of liability which causes injury, whether based on allegations or not, in any way. Should emergency medical services become necessary for the undersigned participant, the expenses are the sole responsibility of myself and not that of Dance Exchange. I understand that this is the entire agreement between myself and Dance Exchange, its owners, officers, board, agents, and employees and that it cannot be modified or changed in any way by the representatives or statements by Dance Exchange or by myself.*

I agree
MEDIA RELEASE: I, hereby grant to Dance Exchange the irrevocable and unrestricted right to use and publish, alter, and copyright quoted material, photographs or video images of myself, audio recordings, text/writings/drawings I produce for Dance Exchange publications, electronic reproductions (website) and/or any other purpose and in any manner or medium an unlimited number of times in perpetuity for any lawful purpose. I hereby release the photographer/videographer/documenter and the Dance Exchange from all claims and liability relating to said photographs/video/audio/text. I understand that the Dance Exchange will exercise care in protecting the context of quoted material or image. I understand that I will not receive any monetary compensation for the permissions I am granting herein. I understand cannot withdraw this consent after I sign this form and that this consent and release is binding.*

I agree
Payment

Please select the sliding scale class fee you are most comfortable paying. $5 is the minimum required.*

FREE Class - September 14 Only

$ Free

Dance On Weekly Class Drop In Sliding Scale Option 1 ($5.00)

$5.00

Dance On Weekly Class Drop In Sliding Scale Option 2 ($10.00)

$10.00

Dance On Weekly Class Drop In Sliding Scale Option 3 ($15.00)

$15.00

Dance On Weekly Class Drop In Sliding Scale Option 4 ($20.00)

$20.00

Total

$0.00

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

Should be Empty:

Dance On Weekly Online Class

Class Date

Participant Information

Emergency Contact Information

Liability and Media Release

Payment