2018 Company Audition Form
Email address *
Last Name *
Your answer
First Name *
Your answer
Age *
Your answer
Date of Birth *
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Address *
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City *
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Zip Code *
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Parent Email Address *
Your answer
Dancer Email Address *
Your answer
Mothers Name *
Your answer
Mother Work Phone *
Your answer
Mother Cell Phone *
Your answer
Father Name *
Your answer
Father Work Phone *
Your answer
Father Cell Phone *
Your answer
In case of emergency and neither parent can be reached, person to contact (name, relationship, home phone, cell phone and work phone) *
Your answer
Primary Physician *
Your answer
Physician's Phone Number *
Your answer
Medical information that we should be aware of (medical history, allergies, regular medications, etc.) *
Your answer
Any "over the counter" drugs not to be used would include *
Your answer
Current medications *
Your answer
Date of last tetanus shot *
Your answer
Which parent has the insurance? *
Medical Insurance Company *
Your answer
Medical Insurance Policy/Plan # *
Your answer
Prescription Drug Company and Plan # *
Your answer
Years of prior ballet training *
Your answer
Years of prior modern training *
Your answer
Years of prior jazz training *
Your answer
Years of prior pointe training *
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Current dance teacher *
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Name of dance studio *
Your answer
Studio address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Academic school attending *
Your answer
Where did you hear about our audition? *
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