Country Swing Lesson

Get ready for an evening of dancing, fun, and learning with the Pilot Butte Summer Ambassadors!

Join Coach Karyss from Dance Collective for a Country Swing Lesson that is perfect for beginners and anyone looking to improve their country swing skills. Come on your own, with a partner, or with friends—everyone is welcome!

Event Details

Date: Tuesday, August 25
Time: 6:30 p.m.
Location: Prairie Lily Field, Pilot Butte
Instructor: Coach Karyss, Dance Collective
Ages: Children are welcome to attend but MUST be be accompanied by and register with an adult

Registration

Please use the form below to register in advance.

PARTICIPANT INFORMATION

Participant Name *

Physical Address *

Age (children may attend but must be accompanied by an adult) *

Phone Number *

Email Address *

Important Information ie; allergies, medications, disability, pronouns, etc:

EMERGENCY CONTACT INFORMATION

Emergency Contact Name *

Emergency Contact 1 - Phone Number *

Emergency Contact 1 - Relationship *

WAIVERS

Waiver of Liability

I agree to release, indemnify and save harmless the Town of Pilot Butte, and its elected officials, officers, employees, agents, representatives, volunteers, and other participants from and against all claims, proceedings and/or actions in respect of any costs, losses, damage or injury arising by reason of my or the dependent registrants’ participation in any activities offered by the Town of Pilot Butte, or by reason of the provision of medical care by the Town to me or the dependent registrants.

Waiver of Liability Agreement * I have read and understand the Waiver of Liability.

Town of Pilot Butte Image Release

I hereby grant permission to be photographed during the program for memorabilia and/or promotional material. I further acknowledge that the Town of Pilot Butte are the owners of all publication materials, and that photos may be used in any exhibitions, public displays, publications, commercial art, and advertising purposes including television without limit or reservation.

Town of Pilot Butte Image Release Agreement * I agree
I do not agree to these terms and do not consent to having my photo taken

* - denotes required field