Skip survey header

2022-2023 Parkinson's in Movement

Parkinson's in Movement registration

1. Please tell us about the participant.
This question requires a valid number format.
This question requires a valid number format.
This question requires a valid number format.
This question requires a valid email address.
2. What is your Race/Ethnicity? Check all that apply (for grant reporting purposes) *This question is required.
  • * This question is required.
6. Have you ever taken a dance/movement class as an adult? *This question is required.
7. Where did you hear about this class? *This question is required.
8. 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.
Clear
Signature of
9. 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.
Clear
Signature of
10. This program is provided free of charge thanks to the generosity of our donors and sponsors. You can help Arts4All Florida continue to provide community art classes by making a donation. Thank you for supporting us and our Teaching Artists!
THANK YOU FOR YOUR DONATION. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE.  REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. OUR REGISTRATION NUMBER IS CH8088.
0%