The Forum

THE FORUM REGISTRATION
Dancer Information
Name*

First NameLast Name
Age*
Pronoun
Email*
example@example.com
How many weeks will dancer attend?
**Note dancers may not join after first week.
Parent/Guardian Information
Name

First NameLast Name
Relationship
example@example.com
E-mail*
example@example.com
Cell Number*

Area CodePhone Number
How did you hear about The Forum?
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Participations, Release, and Medical Agreement

While we make every effort to provide a safe and pleasant environment for every dancer who attends BHumn Dance Productions events, we do require that this participation agreement be read, filled out, signed, and dated by all dancers (or their parent/guardian if under the age of 18) who wish to participate in The Forum held at Joyce Willet School of Dance.

With full knowledge, I accept full responsibility for any injury or accident that may occur to myself, my spouse, or my child while participating in The Forum. I give permission for my child to participate in all activities that occur at The Forum.

For promotional or marketing purposes, BHumn Dance Productions reserves the right to use any audio, video, and/or photography of guests or dancers participating in The Forum.

I, on behalf of myself, my children, my assigns and my estate, agree to release and hold harmless BHumn Dance Productions and Joyce Willet School of Dance, as well as its officers, board, agents or employees, for any and all claims for injuries, causes of action, or liability related to my child's participation in any activity occurring at The Forum.

Should BHumn Dance Productions or Joyce Willet School of Dance, or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold BHumn Dance Productions and Joyce Willet School of Dance harmless for all such fees and cost.

By signing this document, I acknowledge that if anyone is hurt or property damaged during my or my child's participation in these activities, I and/or my child may be found by court of law to have waived any right to maintain a lawsuit against BHumn Dance Productions and Joyce Willet School of Dance on the basis of any claim which has been released herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and agree to be bound to its terms.
Health or Behavioral Conditions:
Drug Allergies or Other Allergic Reactions:
Medication Taken Regularly:
Activity Restrictions:
I give permission for myself or my child to attend The Forum at Joyce Willet School of Dance. I understand that my personal insurance will provide primary coverage for medical aid. I also understand that if myself or my child must be sent home because of disciplinary or other problems, I will waive my right to a refund. IN CASE OF MEDICAL EMERGENCY, I hereby give permission to the physician selected by the workshop director or their agent to hospitalize, secure proper treament for, and order injection, x-ray, anesthesia, or surgery for myself or my child as named previously.

Myself or my child is immunized against the following according to H.E.W standards: Polio, Measles, Mumps, Rubella, Diphtheria, Tetanus, and Whooping Cough.
Insurance Company:
Policy Number:
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature

Clear
Payment: You may choose to pay below with paypal or you can mail in a check with your registration fee.

Checks made payable to BHumn Dance Productions and mailed to 7685 Northcross Dr. #103 Austin, TX 78757. Partial refunds given through April 1, 2025. No refunds available after that time.
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Full Tuition $1,600.00
(July 7-25)

One Week Tuition$675.00
(Only for July 7- 12)

Two Week Tuition$1,300.00
(Only for July 7-19)

Pay by Check or Venmo$ Free
If paying by check or Venmo (cheryl-copeland), Uncheck any above items and select this box ONLY. Please make a note on check or venmo what weeks you are registering for. Payment will reserve your place in the workshop.

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THE FORUM REGISTRATION

Participations, Release, and Medical Agreement

Payment: You may choose to pay below with paypal or you can mail in a check with your registration fee.