UNLV Dance Summer Intensive Registration
Sign in to Google to save your progress. Learn more
Student Information
First Name *
Last Name *
Date of Birth (MM/DD/YY) *
Country of Citizenship *
Contact Number *
Studio Name *
Studio Email *
Parent/Guardian Information (if student is under 18 years old)
First Name
Last Name
Cell Number
Medical Authorization (if student is under 18 years old)
I, (parent/guardian name), am the parent and/or guardian of (minor's name), a minor under the age of 18 years old for the Summer Intensive held at UNLV and hereby authorize UNLV employees to obtain whatever medical and/or hospital care and treatment may be deemed necessary with their sole discretion, while my said minor is attending the Summer Intensive held at 4505 S Maryland Pkwy, Las Vegas, Nevada 89154-5010.
Parent/Guardian Name
Minor's name
Check the appropriate option: *
Check the appropriate option for tuition/scholarship: *
Total *
Check the appropriate option for payment: *
There are no refunds granted. Applicants unable to attend due to injuries or serious illness after submitting payment should email dolly.kelepecz@unlv.edu a signed Doctor’s Certificate stating the reason for the inability to attend. A medical release is required for all participants. An online registration is not a guarantee of space in the program unless tuition due is paid. UNLV is not responsible or liable for any injuries sustained on the premises or during any other activity or performance; and not responsible for any personal items that may be lost or stolen on the premises during the Summer Intensive. Any photography and/or video taken during the Summer Intensive will be the property of UNLV and allowed sole, exclusive, and unlimited usage.
Photo & Video Release Form
I, (Participant), hereby grant permission to the University of Nevada, Las Vegas, the rights of my image, in video or still, and of the likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area. 

Photographic, audio or video recordings may be used for ANY USE which may include but is not limited to:

- Presentations;

- Courses;

- Online/Internet Videos;

- Media;

- News (Press);

By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting.

I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.

By signing this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.

By printing my name, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document and I consent to the legally binding terms and conditions of this document. If I am signing this document on behalf a minor, I represent and warrant that I am the minor's parent or legal guardian. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Nevada, Las Vegas. Report Abuse
Google Forms