Registration Form

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. If you are signing up multiple students please click here. If you are over the age of eighteen (18) please click here.

* Indicates required field

Dancer's Name *

First

Last

Birthdate *

Dancer's Email *

Dancer's Phone Number *

Home Address *

T-Shirt Size *

Contact Information

Mother's Name *

Mother's Email *

Mother's Phone Number *

Father's Name *

Father's Email *

Fathers Phone Number *

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 permission for my child to be photographed and videotaped, and allow Barvinok Dance Ensemble and Ukrainian Association of Washington State to release said photos or videos for publicity and fundraising purposes.

I have read the above, considered its effects, understand its content, and agree, on behalf of myself and my child to the terms as stated above. I will further indemnify the releases against any damages incurred as a result of any action by my child including attorney’s fees and costs.

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.

Legal Guardian's Full Name *

Electronic Signature *

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

Date *

Submit