REGISTRATION FORM - BREAK OUT: Dance Program in ITALY
Program Runs: Aug 11-25, 2020
Name *
First and Last
Your answer
Email *
Your answer
Phone *
Your answer
What stage of training are you in? *
If you know the name of another dancer attending the program whom you would like to room with, please list their NAME and EMAIL below:
Your answer
Registration Payment Info: *
There is a $500 non-refundable deposit to reserve your spot in the program. The remaining balance will be collected in April/May. If you need to withdraw after final payment, 50% of your remaining fees will be returned.
Scholarship Request Paragraph
Amalgamate believes strongly in supporting dance artists and therefore offers scholarships. To apply, 1) Please tell us why you need to attend BREAKOUT and 2) what amount you can afford in registration fees?
Your answer
Your e-signature below signifies that you have read and agree to the following: I hereby release Amalgamate Dance Company (ADC), its instructors, directors, technical crew and all rehearsal, performance, class, and event locations from any liability due to personal injury or loss of property, which I may sustain as a result of participating in any activity with the Company. Part II Photo/Video Waiver: I hereby give permission to Amalgamate Dance Company to use photographs and video that I submit to the company for use on ADC's Website and/or within any other promotional materials. As well, as photographs and video taken of me while dancing with the Company. Thank you! THE BREAKOUT & ADC TEAM *
(full name)
Your answer
How did you hear about this program? *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.