2023-2024 Parkinson's in Movement

Parkinson's in Movement registration

1. Please tell us about the participant.

First Name *This question is required.

Last Name *This question is required.

Home Phone This question requires a valid number format.

Cell Phone This question requires a valid number format.

Street Address *This question is required.

City *This question is required.

State *This question is required.

Zip *This question is required.

Partner/Support/Caregiver Name *This question is required.

Best contact phone number *This question is required. This question requires a valid number format.

Email *This question is required. This question requires a valid email address.

2. What county do you live in? *This question is required.

3. Which session are you registering for? *This question is required.

4. Have you ever taken a dance/movement class as an adult? *This question is required.

5. Where did you hear about this class? *This question is required.

Please enter an 'other' value for this selection.

Payments are now to be directly paid to the instructor. Please arrange your payment options with the instructor directly.

6. Release of liability, waiver of claims, assumption of risks and indemnity agreement. I agree to the following release of liability as a participant in an in-person and/or online program with Arts4All Florida. In the case of any injury to registrant associated with an activity involving Arts4All Florida, the registrant and contractor shall indemnify and hold harmless, and hereby release, discharge, and acquit Arts4All Florida (and their respective directors, officers, members, employees, agents, teaching artists, and independent contractors) from and against any and all claims, damages and liabilities resulting from or associated with said injury or the treatment of said injury. By signing this release, I acknowledge I have read and fully understand this agreement and intend my signature to be an unconditional and complete release of all liability. I also acknowledge that my electronic signature has the same force and effect as an original signature.
*This question is required.

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7. Media Release and Consent Form - In consideration for participating in Arts4All Florida's programs, I hereby give consent to Arts4All Florida to use my name, age, disability, photo, voice, or other likeness for future public awareness including print media, online news distribution, Arts4All Florida website, television and radio opportunities, video, promotional materials and other similar mediums (the "Production").

Such use of the Production is permitted throughout the world or exhibition purposes by Arts4All Florida in whatever manner it may desire, and may be copied, copyrighted, edited and distributed by Arts4All Florida in any medium in perpetuity without any compensation to me. Furthermore, I consent that any such Production shall be the exclusive property of Arts4All Florida and Arts4All Florida shall have the right to use, sell, publish, print, display, distribute, duplicate, reproduce, reprint, create derivative works, and make other uses of such Production as Arts4All Florida may desire, free and clear of any claims whatsoever on my part. I agree that Arts4All Florida can use the Production, in whole or in part, without restrictions as to changes or alterations. I also hereby expressly agree by this written instrument that the Production shall be considered a work made for hire, and Arts4All Florida shall own all copyrights in and to the Production.

In addition to the rights set forth above, I acknowledge and agree that my work that is created through Arts4All Florida programs may be selected, displayed, used, reproduced and/or sold to benefit the ongoing statewide art programming of Arts4All Florida, with no consideration or compensation to me.

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