Dancer's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Please select which weeks your dancer plans to attend. *

Week One (June 26th - June 30th)

Week Two (July 3rd - July 8th) No class July 4th.

Week Three (July 10th - July 14th)

Week Four (July 17th - July 21st)

Week Five (July 24th - July 28th)

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Phone *

(###)

###

####

Parent/Guardian Name *

First Name

Last Name

Please contact me to schedule a trial/audition for my dancer. *

Yes

No