Registration
here to log in to the parent portal to see or edit class, student, and payment information.
Please e-mail
maleen@cohesiondance.org
if you have any questions or are interested in Volunteer Scholarship Exchange. "/>
Already a customer? Click here to login.
Join Cohesion Dance Project for a modern-based master class featuring choreography from their show "Resonance~ an evening of Art Inspiring Art." This class is free and open to intermediate and advanced level dancers ages 10 through adult.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Other
Parent
Partner
Self
Sibling
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact: Name, Phone, Relationship
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Physical or medical conditions/restrictions (leave blank if none):
Allergies (leave blank if none):
Photo Release (Y/N):
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Physical or medical conditions/restrictions (leave blank if none):
Allergies (leave blank if none):
Photo Release (Y/N):
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Physical or medical conditions/restrictions (leave blank if none):
Allergies (leave blank if none):
Photo Release (Y/N):
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Physical or medical conditions/restrictions (leave blank if none):
Allergies (leave blank if none):
Photo Release (Y/N):
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Physical or medical conditions/restrictions (leave blank if none):
Allergies (leave blank if none):
Photo Release (Y/N):
*
Additional Information:
Liability Release
(Show-Hide Details)
Please read this form carefully and be aware that in agreeing for yourself or on behalf of your child, you
acknowledge the risk of harm as a result of participating in any Cohesion Dance Project program.
Cohesion Dance Project offers dance programs to participants, including classes, rehearsals, and
performances. Dance is an activity in which, despite preparation, instruction, medical advice,
conditioning, and equipment, there is still a risk of injury, including but not limited to the following:
heart attack, stroke, and circulatory problems; bone and joint injuries; muscle strain and other muscle
injuries; foot problems.
As a participant or parent/guardian of a participant in the program, I acknowledge there are certain risks
of injury, and I agree to assume those risks of injury which I or my minor child may sustain as a result of
participating in any and all activities connected with or associated with such a program. In the event of
any emergency, I authorize Cohesion Dance Project officials to secure from any licensed hospital,
physician, or medical personnel any treatment deemed medically necessary for me or my minor child's
immediate care, and I agree I will be responsible for payment of any and all medical services rendered.
I have read and fully understand the above and acknowledge the risk of harm as a result of participating
in any Cohesion Dance Project program. I understand this agreement may not be modified orally.
I've read the above and agree.
Photo Release
(Show-Hide Details)
I give permission for Cohesion Dance Project to use any photos or video of my child or myself (if over 18) for educational or promotional reasons.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Please Wait...
