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    Additional Info.

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    1. Thank you for your interest in Teens Activate! Please answer the questions below to complete your registration.
      1. Parent/ Guardian Name: *
      2. Student Name: *
      3. Student Date of Birth (Please keep in mind that this program is only intended for teens aged 15-18) *

    Payment Details & Billing Address.

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    1. Become a Participant

      A registration fee is required to participate. Please select a registration tier below.

    2. $200

      This for Week 1, virtual, only.

    3. $200

      This is for Week 2, virtual, only.

    4. $300

      This is for both Weeks 1 & 2, virtual.

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    General and Movement
    I hereby give my consent for the above named student to complete and participate in Core Dance’s Teens Activate Summer Program. I hereby release and discharge Core Dance, including their officers, employers, participants, and volunteers (herein collectively referred to as Core Dance) from all liability arising out of or in connection with the above described activity or all liabilities associated with any and all claims related to such activity that may be filed on behalf of or for the above named minor. For the purposes of this agreement, liability means all claims, demands, losses, causes of action, suits or judgments of any and every kind that occur during the above described activity and that result from any cause including the active or passive conduct and/or negligence of Core Dance.

    I acknowledge on my behalf and on the behalf of the above named minor that there are risks inherent in the above-described activity, including the risk of serious injury that may occur through the conduct of other participants, instructors, Core Dance, including conduct that may not be part of the ordinary risks of the activity itself. For example, injury may occur through conduct that is not authorized by the rules and regulations of the activity. This release and waiver as set forth in the above paragraph shall also apply to this type of conduct and any resulting injury.

    I also represent that the above name participant has undergone a medical examination by a licensed physician within one year preceding the date this document is signed, in good health, and fully able to participate in the activities provided by the camp, including activities which are strenuous in nature.

    We, the parents of the above child, herby give my/our approval for her/his participation in activities during the current session. We assume all risks and hazards incidental to the activities. In case of injury to my child, I/We hereby waive all claims against Core Dance, the owner, instructors, and employees. I/We release from responsibility any person transporting my child to the doctor, or hospital in case of injury.

    We agree to pay the dance camp fee at the time this form is presented. Please note that summer dance camp can be cancelled due to lack of participation, in this event, a full refund will be issued to the payer. In the event the student registered above decides to discontinue camp mid-session, I will inform Core Dance by phone or email and I understand that I will not receive any refunds.

    Photography and Video
    I/We authorize Core Dance to take photos and/or video of program sessions. This media can be used for archival and promotional purposes.

    I have carefully read this waiver and release of liability and fully understand its terms and condition and understand that by signing this document that I have given up substantial rights for the named participant/minor and myself.

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