Event Registration Form — Studio Unique

1 Primary Contact Information

First Name *

Last Name *

Email Address *

Phone Number

Date of Birth *

2 Home Address

Street Address *

City *

State *

ZIP Code *

3 Household Information

Total Household Size *

Annual Household Income

Additional Household Members (name / role / age):

Member 1

Role (child / adult / senior)

Age

Member 2

Role

Age

Member 3

Role

Age

Member 4

Role

Age

4 Photo & Video Waiver

Parent / Guardian Photo & Video Release — Studio Unique

I hereby grant Studio Unique, a 501(c)(3) non-profit performing arts organization, permission to photograph, film, and/or record my child(ren) and/or household members during Studio Unique events, workshops, performances, and programs.

I understand and agree that these photographs, videos, and recordings may be used by Studio Unique for educational, promotional, and fundraising purposes, including but not limited to: the Studio Unique website, social media channels, newsletters, grant applications, press releases, and printed materials.

I understand that no names will be published alongside images without my separate written consent. I agree that all media collected remains the property of Studio Unique and may be used without compensation to me or my household members.

This release applies to all Studio Unique events and activities attended under this registration unless I provide written notice of revocation to Studio Unique.

I agree to the Photo & Video Waiver above on behalf of myself and all household members listed in this registration.

I decline the Photo & Video Waiver. Studio Unique will not photograph or record my household members.

Printed Name (Parent / Guardian) *

Date *

5 Your Interests (check all that apply)

Dance – Ballet

Dance – Contemporary

Dance – Hip-Hop

Dance – Jazz

Dance – Tap

Dance – Ballroom

Dance – African

East Coast Swing

West Coast Swing

Dance – Hustle

Dance – Salsa / Latin

Breakdancing

Dance – Kizomba

Media Program

Line Dancing

Dance – Stepping

Country Two-Step

Music – Vocals

Music – Piano

Music – Guitar

Music – Violin

Music – Drums / Percussion

Music – Wind Instruments

Music – Choir

Theater – Acting

Theater – Musical Theater

Theater – Spoken Word

Other

6 Event Payment via Zelle

Send payment to Studio Unique via Zelle: [email protected]

Admission prices vary by event — check the event flyer for the exact amount
Include your full name and the event name in the Zelle memo
Cash is also accepted onsite at all Studio Unique events
Questions? Contact us at [email protected]

7 Agreement & Signature

I confirm that the information provided is accurate and I agree to Studio Unique's event policies. I understand that event admission payment via Zelle or cash is required to participate.

Signature *

Date *