The Dance Gallery Summer Intensive (July 16th- 20th)
*Upon receipt of this completed registration form, we will contact you regarding payment. Please note that your child is not registered until full payment is received. Faculty will determine placement of dancer....we thank you in advance!
Email address *
I am registering for *
Dancer's Name (Last, First) *
Your answer
Dancer's Date of Birth *
Your answer
Please give a brief description of dance experience, including any programs/classes *
Your answer
Parent/ Guardian (Last, First) *
Your answer
Contact Email/ Phone Number *
Your answer
I would like to pay by ...(for security purposes, we will contact you via email and arrange payment...thank you!) *
Medical Concerns/ Allergies/ Special Requirements *
Your answer
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