Workshop Registration

Parent's Name(Required)

First Last

Email(Required)

Phone(Required)

Dancer's Full Name(Required)

Dancer's Age(Required)

Which workshop will this dancer be attending?(Required)

Is this dancer currently enrolled in a class at Johnstown Concert Ballet?(Required)

Yes

Workshop Fee(Required)

Price:

Do you need to register a second dancer?(Required)

Yes

Second Dancer's Full Name(Required)

Second Dancer's Age(Required)

Which workshop will the second dancer be attending?(Required)

Is the second dancer currently enrolled in a class at Johnstown Concert Ballet?(Required)

Yes

Second Dancer's Workshop Fee(Required)

Price:

Do you need to register a third dancer?(Required)

Yes

Third Dancer's Full Name(Required)

Third Dancer's Age(Required)

Which workshop will the third dancer be attending?(Required)

Is the third dancer currently enrolled in a class at Johnstown Concert Ballet?(Required)

Yes

Third Dancer's Workshop Fee(Required)

Price:

Participation Liability Waiver & Release(Required)

I hereby consent to the student(s) participation in all dancing programs, recitals and activities of and provided by JOHNSTOWN CONCERT BALLET (JCB), its principals, employees, and agents. I recognize that there are risks inherent in dance training, including but not limited to serious physical injury. I, on behalf of the participant, and myself agree to indemnify and hold harmless the JCB, its instructors, officers, directors, agents, and employees against any liability resulting from any injury that may occur to the participant while participating in activities of the JCB. I agree to release JCB from any and all liability and waive as against JCB all recourse, loss or damage, including any consequential damage or loss, claims, causes of action of any kind whatsoever arising from his/her participation in the activity. I acknowledge and understand that there are risks inherent in dance training and performances and that these are risks inherent in dance training and performance and that these activities by their very nature can be dangerous exposing participants to risks and hazards and that I nevertheless freely and voluntarily assume all of the aforesaid risks and hazards. I HAVE CAREFULLY READ THE LIABILITY WAIVER/RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS CONTENT AND SIGNIFICANCE. ADDITIONALLY, I HAVE READ AND AGREE TO ABIDE BY ALL POLICIES AND PROCEDURES OF THE JOHNSTOWN CONCERT BALLET.

Photo/Video Release(Required)

I hereby grant permission to Johnstown Concert Ballet, its authorized representatives, staff or Board Members, to take and use photographs, videotape and/or digital images of the student(s) for use in publicity, illustration, publishing (including publishing in electronic form), or other lawful uses as may be determined by Johnstown Concert Ballet. I further agree that my name and identity may be revealed in descriptive text or commentary in connection with the use of such image(s). I authorize the use of these images indefinitely without compensation to me. All negatives, positives, prints, digital reproductions and videotape shall be the property of Johnstown Concert Ballet.

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Total

Payment Method

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

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