Dance On Weekly Online Class

Dance On Weekly Online Class

Drop-In Registration
September 18, 2025 - June 25, 2026

Thursdays 11:00 AM – 12:00PM ET on Zoom
Sliding scale $10 - $25 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?*
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
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
LiveWorkOut of the area
How did you hear about our program?
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.Format: (000) 000-0000.
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

If cost presents a barrier to participation, please email registration@danceexchange.org to inquire about Dance On scholarship opportunities.

Please select your payment amount from the sliding scale below*

Dance On Weekly Class Drop In: Pay-It-Forwward Rate ($25.00)

This rate helps cover your participation and supports scholarships for others. If you are able to contribute at this level, you help make the class series more accessible for all.

$25.00

Dance On Weekly Class Drop In: Standard Rate (True Cost)($20.00)

This reflects the actual cost of running the class series. Choosing this rate helps us sustain the full scope of the program.

$20.00

Dance On Weekly Class Drop In: Supported Rate ($10.00)

This rate helps keep our classes accessible while supporting program sustainability. If this cost still feels out of reach, please email registration@danceexchange.org and inquire about Dance On scholarship opportunities.

$10.00

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