Summer Dance Intensive '25 JR Registration Form

Summer Dance Intensive '25 JR Registration Form - June 9-13, 2025

Just like Inlet’s longstanding Summer Dance Intensives, SDI Jr focuses on creating a supportive community for young dancers ages 6-12, exposing students to the collaborative dance-making process, and increasing technical and performance skills. SDI Jr. will give students the opportunity to make meaningful connections with other students using dance to build empathy.
Student Name*

First NameLast Name
Student Cell Phone Number, if applicable

Area CodePhone Number
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
FemaleMaleOther
She/Her/HersHe/Him/HisThey/Them/TheirOther
Student Age*
Student Birthday*

MonthDayYear
Date
School Attending
school name and grade/ year

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

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

Dance Experience
1st Parent/Guardian Name*

First NameLast Name
1st Parent/Guardian Phone Number*

Area CodePhone Number
1st Parent/Guardian Email
example@example.com
2nd Parent/Guardian Name

First NameLast Name
2nd Parent/Guardian Phone Number

Area CodePhone Number
2nd Parent/Guardian Email
example@example.com
Parent/Guardian Address IF different

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
$280 = Full Day Program: 9am- 3pm (w/lunch break)$180 = Half Day Program: 9am-12:00pmAftercare 3pm-5pm = $10/hour (Please check if you are planning to utilize this, however we will wait to bill for this cost during camp week)Before care 8-9am = $10/hour (Please check if you are planning to utilize this, however we will wait to bill for this cost during camp week)I've applied for a scholarship.If you would like to help support another student cover their tuition costs, please consider donating a gift of $50, or any amount of your choice.
$50 Non-Refundable Deposit due with Registration, that will go towards your tuition balance.

Scholarships and Payment plans are available. Contact the Inlet office (info@inletdance.org) 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.
InternetFacebookFriendMailingPosterSchoolMasterclassOther

Medical Information
Doctor Name

First NameLast Name
Doctor Phone #

Area CodePhone Number
Medical Conditions and Injury History (Please list ALL current and previous)*
Medications (Please List ALL medications and what they are treating) *
Please specify if any of the above medications will be taken during the time your student is in our care.
Please list any Food Allergies:
Primary Emergency Contact*

First NameLast Name
Primary Emergency Contact Phone Number*

Area CodePhone Number
Primary Emergency Contact Relationship to Student
Secondary Emergency Contact

First NameLast Name
Secondary Emergency Contact Phone Number

Area CodePhone Number
Secondary Emergency Contact Relationship to Student
Waivers
I understand that dance instruction requires a broad range of movements that may strain the human body. If my child experiences any pain or discomfort in class, he/she 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 my child is uncomfortable with physical corrections, he/she 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 child’s 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 my child is 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 my child at Inlet Dance Theatre’s Summer Dance Intensive Jr 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 and Pivot Center for Art, Dance & Expression, its successors, and assigns, and its officers, directors, shareholders, employees, and agents, and their heirs, executors and administrators.
Signature *

Signature of participants +18 yrs or parent/guardian
I hereby grant Inlet Dance Theatre the absolute and irrevocable right and unrestricted permission in respect to photographic portraits/pictures or video taken of my child in which he/she 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 child’s 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.
Signature:

Signature of participants +18 yrs or parent/guardian
Due to security reasons, I DO NOT grant Inlet Dance Theatre permission to take or publish in any form or forum photos/pictures/videos of my child.
Signature:

Signature of participants +18 yrs or parent/guardian

Almost there!

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

Please select a payment option below to make your $50 non-refundable deposit (this deposit will be applied towards your final balance)

*Inlet Dance Theatre reserves the right to cancel our Summer Dance Inntensive 25 JR if enrollment is too low. Registered students will be notified by May 19, 2025 and will be fully refunded.
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 44113I will pay the deposit online through PayPal, link provided after submitting the form.
Should be Empty:

Summer Dance Intensive '25 JR Registration Form - June 9-13, 2025

Medical Information

Waivers