Registration for CSU Community Dance Class

CSU Community Dance Class (In-Person)

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email:*
Emergency Contact Telephone Number*
Name of Health Insurance Carrier*
Policy Number*
Current Age*
Parent/Guardian Name (if under 18 years of age)
Parent/Guardian Email (if under 18 years of age)
Please choose one:*
- CSU Dance Major
- CSU Student (Non-Dance Major)
- CSU Faculty or Staff
- Fort Collins Dance Community Member
- Other
Consent*
I understand, accept, and assume all such hazards and risks, and waive all claims against the State of Colorado, The Board of Governors of the Colorado State University System, and Colorado State University, and other persons as facilitating this event, including students, faculty, staff, and/or invited guest artists.*
I agree to the above
Media Recording*
CSU may record participants’ appearance on video, audio, photography, or other media and may use participants’ names, likeness, and/or voice in connection with these recordings. CSU may use, reproduce, distribute, publicly display and/or perform these recordings, either electronically or by any other media, whether now known, or hereafter existing. CSU may allow others to do the same for any purpose related to CSU’s mission, including without limitation, promotional or educational. I give my consent for CSU to publish, republish or otherwise transmit the images of myself, or my child, in any media for all purposes. I understand the images may be altered or modified and that recordings shall be the property of Colorado State University. I authorize the use of these materials indefinitely without compensation to me.
I agree to give media recording consent as outlined above