2019 Summer CONTEMPORIZE! Registration Form
Email address *
Name *
Your answer
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian Name *If Under 18
Your answer
Parent/Guardian Email *If under 18
Your answer
Address (city, state & zip code) *
Your answer
Contact Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Any health problems or allergies we should be aware of?
Your answer
What day(s) will you be attending? *
Required
Did you receive or qualify for a scholarship/discount? *
If yes, what is your discount code?
Your answer
*IMPORTANT* To receive a full scholarship or discount you must attend BOTH days. If you can only attend one day, you may use HALF of your scholarship/discount.
Payment Amount *
Would you like to purchase a piece of NEW BCDP 2019 apparel for $12?
I paid this amount of money (code and apparel included): *
Your answer
*There will be no refunds after registration*
Payment Method
YOU MUST PRINT OUT THIS FORM, SIGN IT, AND BRING IT WITH YOU TO CONTEMPORIZE!
I understand that if I do not bring the signed form above I will not be able to participate in classes at CONTEMPORIZE! *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service