Dance for Social Change (DSC) Youth Summer Programs 2025 Registration Form

Please complete the following form to register your child for the upcoming Dance for Social Change (DSC) Summer Programs. Be sure to read the following program descriptions clearly to make sure you are registering your young person for the correct program!

Tuition/Registration Fee
DSC Juniors Summer Camp- $400 for 4 weeks
Scholarships/financial aid are available!

Because of the current political atmosphere, we are not able to offer our programs for free this summer. However, we still want to ensure our programs are still accessible to our families. We will NEVER turn away a family due to lack of funds. Please do not hesitate to ask us for assistance if you need it! Our financial aid program is need-based and factors in household income, family size, and the case-by-case situation of each family individually. We do not require the submission of any financial paperwork. We trust our families and rely on their honesty in communicating how much they can afford to contribute to the program.

Note: After this form is submitted a Dancing Grounds/ Dance for Social Change representative will reach out to collect your deposit to hold your student's place. Registration is not complete until after your deposit has been submitted.

Programs:
Dance for Social Change (DSC) Juniors Summer

Ages: 7-12 (rising 3rd- 7th graders)

Dates: July 7, 2024 - August 1, 2024 (Final Performance August 2)

Location: Dancing Grounds 3705 St. Claude Ave New Orleans, LA 70117

** Freedom School is being rescheduled to another time. If you would like for us to reach out for future teen opportunities, please complete the Interest form here
DSC Freedom School

Ages: 13-19 (rising 8th- 12th graders)
Dates: July 21 2024 - August 1, 2024 (Final Performance August 2)

Location: New Orleans Dance Collective (3232 N Galvez St. New Orleans, LA 70117)

*stipends available for active participation and attendance during program

What program are you registering your child for?

Student Information

Youth First Name

Youth Last Name

Youth Email

Youth Phone Number

Youth Birthdate DD/MM/YYYY

Address

Street

City

State

Zipcode

School Attending

Grade Level

Other

Race/Ethnicity

Other

Gender Identity

Pronouns

Anything else you would like us to know you about your child's gender identity?

T-Shirt Size

How did you hear about Dancing Grounds' youth programs?

Other

Does your child have any learning exceptionalities and/or an IEP at school?

What do you want us to know about your child? Anything related to their learning style? Their personality? Their interests? Their past experiences in dance class?

Does your child have any allergies we should be aware of? Other medical conditions or considerations we should know about? Please provide as much detail as possible so we can best support your child!

Does your child qualify for free or reduced price lunch at school?

Parent/Guardian Information

First Name

Last Name

Phone Number

Birthdate

Occupation

Employer

Address

Street

City

State

Zipcode

Hometown

Gender Identity

Other

Pronouns

Anything else you would like us to know you about your gender identity?

Race/Ethnicity

Other

Does your child have a Second Parent/Guardian?

YesNo

Second Parent/Guardian Information

*If there is no Second Parent/Guardian, choose 'No' for question: "Does your child have a Second Parent/Guardian?"

First Name

Last Name

Phone Number

Birthdate

Occupation

Employer

Address

Street

City

State

Zipcode

Hometown

Gender Identity

Other

Pronouns

Anything else you would like us to know you about P/G2's gender identity?

Race/Ethnicity

Other

Do you want this contact to also receive ALL communications related to the program?

Emergency Contact 1

Please enter an Emergency Contact that is not a Parent or Guardian

This information is only used in case of emergencies when we cannot contact either parent or guardian. If you have no other emergency contacts, please leave the field blank

Name

Relationship to Student

Mobile Phone

Emergency Contact 2

Please enter an Emergency Contact that is not a Parent or Guardian
This information is only used in case of emergencies when we cannot contact either parent or guardian. If you have no other emergency contacts, please leave the field blank

Name

Relationship to Student

Mobile Phone

Releases

LIABILITY RELEASE: I give permission for the child listed above to attend Dancing Grounds’ Youth classes. I agree to hold Dancing Grounds harmless against any injury, liability, or accident that takes place in rehearsals, classes, or performances administered by Dancing Grounds. I understand that the staff may dismiss my child from the program if his/her conduct jeopardizes the safety of the entire group.

COVID-19: Client understands and acknowledges that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization and the United States Center for Disease Control. Client and Clients’ associates understand that COVID-19 is highly contagious and believed to be spread by person-to-person contact. Client acknowledges that DG has put reasonable, preventative measures in place targeted to reduce the spread of COVID-19. However, Client fully acknowledges that DG cannot guarantee that Client and Clients’ associates will not be infected with COVID-19 through Clients' participation in DG activities. By signing this Agreement, Client acknowledges the contagious nature of COVID-19 and VOLUNTARILY ASSUMES THE RISK that Client may be exposed to or infected by COVID-19, and that such exposure or infection may result in illness, personal injury, permanent disability, or death to Client or those with whom Client may have contacted or may come in contact with. Client further expressly agrees to all of the following: 1. Client understands that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of Client or others; 2. Client voluntarily assumes all of the foregoing risks and accepts sole responsibility for any COVID-19-related illness or injury, including, without limitation, personal injury, illness, disability, or death, damage, loss, claim, liability, or expense of any kind that Client may experience in connection with Renters’ attendance at DG; 3. Client hereby releases, covenants not to sue, discharges, and holds harmless DG of and from any and all claims, including liabilities, claims, actions, damages, costs, or expenses of any kind, relating in any way to COVID-19; 4. Client agrees to comply with all of DG’s Covid safety procedures; 5. If Client texts positive to COVID-19 within 14 days of participating in a DG activity, Client MUST notify DG Staff. Clients understands that these procedures may change from time to time and agrees to abide by any procedures as amended.

PHOTO/VIDEO RELEASE: I consent to the use by Dancing Grounds of name and/or photograph/video of the child registered above for any purpose and in any medium without my inspection of finished photographs or media, and without any liability to me stemming from any such use. *Dancing Grounds may use photos and videos of classes for marketing materials, website, brochures, and grant applications and reports.

CHILD TRANSPORTATION RELEASE: There may be limited instances in which DG can offer assistance with transporting my child to and from programs or events. I give permission for my child to be transported in the vehicle of Dancing Grounds Staff, Faculty or Parent in the case transportation is needed to bring my child to a program or event.

PHYSICAL CONTACT RELEASE: I consent to Dancing Grounds teaching faculty making physical adjustments to my child during dance training.

Which tier of our sliding scale would you prefer?

Here are some suggestions based on annual household income. No one will be turned away for lack of funds! Please reach out if you would like to receive financial assistance.

ex: $0 to $50,000 = $50
$50,0001 to $100,000 = $100
$100,001 and beyond = $150 to $200

$50$100$150I would like to request a need-based scholarship.