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INCLUDE Student Information and Registration
This form must be completed prior to your student participating in any INCLUDE class with Mid-Columbia Ballet. It is only necessary to complete a form for the Summer Session if information about your child has changed since their last INCLUDE workshop. Please note that this form does not indicate payment in the workshop, which must be completed at the following link: http://midcolumbiaballet.tix.com/Schedule.aspx?OrgNum=1719&framed=true.

INCLUDE is a dance workshop designed specifically for children with special needs such as autism spectrum disorder and related disabilities.

Email address
Child's First and Last Name
Child's Age
Help us get to know your child! What are some of his/her favorite things? Are there any tactile, visual, auditory stimulus that are triggers? Is your child able to participate in a class without one-on-one assistance (this is not a requirement of class participation)?
Briefly explain any dance, theatre, or music experience that your child has had in the past. (Previous experience is not required!)
Parent/Guardian #1 (First and Last Name)
Parent/Guardian #1 Cell Phone
Parent/Guardian #2 (First and Last Name)
Parent/Guardian #2 Cell Phone
Please list any days/dates that you will not be able to attend this session (July 24-28, 2017; Monday-Friday)
How did you hear about INCLUDE?
There will be a photo and video documentation of this workshop. Do you give permission for your child's image to be used in print, web and otherwise? MCB makes no compensation for use of images.
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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