Pop-Up Registration Form

Welcome to the STEM From Dance Pop-Up registration form.

Join us for a day of exploring STEM and dance. Learn how you can use these two fields to understand the world, express yourself, and create something inspiring. 

This form includes parent/guardian waivers which must be completed and submitted in order to participate in the pop-up event.

Student Information



Provide a personal non-school email for the student. Each student must have a unique email address.

Provide a unique personal email for each student applying if you can (non-school email).


Student must be btw ages of 8-18 to participate in this program.





School Information


We gladly welcome girls of all backgrounds! 

Select all that apply.
Parent/Guardian Details







Tell us more about yourself:



Select all that apply.


Anything else?


Parent/Guardian Waivers

For the student to be allowed to participate, the following enrollment waiver must be completed by a parent or guardian.
ACKNOWLEDGMENTS AND AGREEMENTS OF STUDENT AND PARENT/GUARDIAN

I, Student and, if Student is under the age of 18, parent or legal guardian (“Parent/Guardian”) of the minor Student, for myself and on behalf of the Student, if applicable, acknowledge and agree as follows:

1. Conduct and Capability to Participate.  I acknowledge and agree that Student will follow direction from STEM from Dance staff and is to abide by all rules and regulations governing conduct during the program. 2. Photo/Video Consent. In consideration for the opportunity for Student to participate in the program and in connection with the programs, I give permission for STEM from Dance, including its owners, agents, volunteers, assistants, employees, contractors, guest artists, and faculty members (collectively, the “SFD Affiliates”) to photograph, video, film, and interview Student and to use Student’s statements, image, voice, likeness, bio, and/or story in any format, including photos, film, video, audio, print or electronic, and grant to STEM from Dance the perpetual and worldwide right and license to use such materials in their sole discretion to promote, advertise, and provide information concerning STEM from Dance’s programs, events, and operations.  I understand that the foregoing license includes use of the materials on print and electronic media and that these materials may be made available to students and parents/guardians as requested. I acknowledge that neither the Student nor II will not receive any compensation for using such materials and that I have been fully advised of STEM from Dance’s intended use of the materials and understand the same. 3. Release and Discharge. I understand that by signing this form, I hereby release and discharge STEM From Dance, the SFD Affiliates, and/or other students (the “Released Parties”) from any and all claims of injury or loss which Student may suffer, arising in whole or in part from Student’s enrollment or participation in the program, including but not limited to any injury, accident, illness, loss or damage to property occurring during the program. I acknowledge that I will not seek to have STEM From Dance held liable in the event that any accident, injury, loss of property, or any other circumstance or incident occurs during or as a result of my child’s participation in the program. 4. Assumption of Risks.  I understand that participating in the program activities involves certain risk and that injuries, death, property damage or other harm could occur to the Student and others. I acknowledge and expressly assume all risks and dangers associated with all program activities, known or unknown, and inherent or otherwise whether the risks and dangers were caused in whole or in part by the negligence of the Released Parties.  I understand that although Student will be supervised by STEM From Dance faculty and staff, I do assume the risk in Student’s participation in the program. 5. Waiver of Claims. I further hereby voluntarily agree to waive any and all claims against any of the Released Parties for any such damage, loss, injury, or any other circumstance or incident during or because of Student’s participation in the program whether it was caused in whole or in part by the negligence of the Released Parties. 6. Indemnification for Injury Caused by Student.  I acknowledge that I, as Parent/Guardian of Student, may be held liable and responsible for any injury or death to another person or injury to property of another caused by Student, as required by law.  I hereby agree to indemnify, meaning to defend, and to satisfy by payment or reimbursement, including costs and attorney’s fees, and hold harmless the Released Parties with respect to any claims of injury, death or other loss or damage to person or property suffered by any person arising in whole or in part from the conduct of Student while enrolled or participating in the program. 7. General Provisions. I understand that this agreement will be binding to the fullest extent permitted by law. If any provision of this agreement is found to be illegal, invalid or unenforceable, the remaining terms will be effective.

SECTION TO BE COMPLETED BY PARENT/GUARDIAN

I acknowledge that I have carefully read this document, waiver, and release, and understand the information therein.  My signature on this form shall constitute an informed and knowing waiver as required by law.  I agree to each of the terms and acknowledgments above and agree to permit my child to participate in the program described above.
ENROLLMENT E-SIGNATURE



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