Summer Intensive Level B (6-week) Registration Form 2018
June 18 - July 27, 2018
Email address *
Email Address (Parent/Guardian) *
Your answer
Dancer's Name *
Your answer
Dancer's Age *
Your answer
Academic School *
Your answer
Grade Level in School *
Your answer
Current Dance School *
Your answer
Years of Ballet/Dance Training *
Your answer
Years of Pointe Training (if applicable) *
Your answer
Mother's Name *
Your answer
Mother's Contact No *
Your answer
Father's Name *
Your answer
Father's Contact No. *
Your answer
Emergency Contact's Name *
Your answer
Emergency Contact's Relationship to Dancer *
Your answer
Emergency Contact's Phone Number *
Your answer
Does your Dancer have any health issues that we should be aware of? *
Your answer
Primary Physician's Name and Contact Information *
Your answer
Deposit Payment ($500) due April 1, 2018 *
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