Registration Form

Registration Form for Adults

Before completing the registration form, please make sure to carefully review the contents of our registration packet. It includes important information about each group, instructors, tuition and fee information, our practice schedule, and Barvinok rules.

* Indicates required field

Name *

First

Last

Birthdate *

Email *

Phone Number *

Home Address *

T-Shirt Size *

Comments/Concerns about this upcoming season *

I freely and knowingly assume all risks incidental to participating in Barvinok Dance Ensemble and I hereby waive any rights, claim or course of action against Barvinok Dance Ensemble and Ukrainian Association of Washington State their officers, directors, employees or agents, releasing them from any liability arising out of an injury, direct or indirect. I also give my permission to be photographed and videotaped, and allow Barvinok Dance Ensemble and Ukrainian Association of Washington State to release said photos and videos for publicity and fundraising purposes.

I have read the Barvinok Dance Ensemble by-laws in the registration packet; I understand the stated rules and conditions and agree to follow them.

Full Name *

Electronic Signature *

By checking this box I acknowledge I have read and understand the terms of this agreement

Date *

Submit