Registration

First Name: First Name is required.

Last Name: Last Name is required.

Preferred Dance Role for this workshop:

Street Address:

City:

State/Province:

Zip/Postal Code:

Telephone:

Email: Email is required. Improperly formed address.

Optional Code:

	Item Name		Price		Totals
	Workshop Pass		$50.00		$50.00
	Amount to be paid:				$50.00

Pressing [Submit] below will submit your request for registration. After submitting the form, you will be directed to PayPal where you can make a payment and complete the registration process. Currently PayPal is the only method available for students to pay for online registration.

By pressing [Submit], you agree that the above information is correct. You agree to pay, via Paypal, the amount above to Groove Juice Swing to be enrolled at LaTasha Barnes Workshop. You agree to the waiver below.

Waiver of liability

I hereby waive any and all liability claims against Groove Juice Swing, its Board of Directors, their agents and instructors or their agents for any and all injuries which I might suffer during, and/or as a result of, my participation in the LaTasha Barnes Workshop event and dances, Sunday, February 8, 2026 through Sunday, February 8, 2026 in Rochester, NY and its surrounding areas and parking lots.

I also assume all responsibility and liability for any injuries I might suffer, or cause, during, and/or as a result of my participation in LaTasha Barnes Workshop event and dances, Sunday, February 8, 2026 through Sunday, February 8, 2026 in Rochester, NY and its surrounding areas and parking lots.

Furthermore, I absolve Groove Juice Swing, its Board of Directors, their agents of any and all responsibility for future injuries I might suffer or cause as a result of my participation in LaTasha Barnes Workshop event and dances, Sunday, February 8, 2026 through Sunday, February 8, 2026 in Rochester, NY and its surrounding areas and parking lots.

I understand that LaTasha Barnes Workshop event is a drug free environment, and that smoking will be permitted only outside the buildings during the event, subject to the policies of the hosting facilities.

By executing this waiver, I state that I am in good physical and mental health and know of no reason why I should be unable to fully participate in this activity.