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Centennial Youth Ballet Summer Intensive
June 3-14, 2019, 9 am-5 pm / $400
Please fill out the following information so that we may reserve a place for your child. Application and 50% deposit are due by May 17. Pay online at www.friendsofmetrodance.org or mail a check made out to Friends of Metro Dance to:

Metro Parks Dance Division
Attn: Centennial Performing Arts Studios
P.O. Box 196340
Nashville, TN 37219-6340

If you have further questions regarding the Summer Dance Intensive, please call (615) 862-8439.

CONTACT INFORMATION
STUDENT NAME (Last, First) *
Your answer
AGE *
Your answer
DATE OF BIRTH *
Your answer
PARENT/GUARDIAN NAME *
Your answer
PARENT/GUARDIAN E-MAIL *
(please include an e-mail for any adult that should receive intensive-related information)
Your answer
STUDENT E-MAIL
(for intensive-related information only)
Your answer
CELL PHONE *
Your answer
HOME PHONE (if applicable)
Your answer
ADDRESS *
Your answer
CITY, STATE *
Your answer
ZIP *
Your answer
ALTERNATE CONTACT / RELATIONSHIP *
Your answer
PHONE *
Your answer
NAME OF ADULT PICKING UP STUDENT EACH DAY *
Your answer
HOW MANY YEARS OF TRAINING HAS THE STUDENT HAD IN EACH OF THE FOLLOWING DISCIPLINES?
BALLET *
Your answer
POINTE *
Your answer
CONTEMPORARY or MODERN *
Your answer
IN WHAT SCHOOL(S) HAS THE STUDENT STUDIED DANCE? Please include the year or years the student studied in each program. *
Your answer
ASSUMPTION OF RISK NOTICE
All students enrolling in Metro Parks dance classes are hereby notified of the following participation policy. *
Parents/Students should be cognizant of inherent dangers in participating in a physical activity. All students should be in good physical condition and be capable of performing the class activities. All students must be covered by full, comprehensive medical insurance to cover any injuries sustained during the dance class. Parents/students assume all risks in connection with the course in which they are enrolled. Parents/students should apprise the instructor of any special physical or medical limitations they have at the beginning of class.
Required
PHOTO RELEASE
I agree to allow my child's photograph to be used on the Metro Parks Dance Division and/or Friends of Metro Dance website and/or Facebook page. Photographs will be of classes/performances/workshops and will not identify the children by name without further permission. *
E-MAIL LIST
I would like to receive the following e-newsletters:
HEALTH HISTORY
Does the student have any injuries (current or prior), allergies, or medical conditions we should be aware of? Please include all pertinent information. *
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