Summer Intensive Registration Form

Student's Name:________________________________________

Student's Age:_____________ Date of Birth:_________________

Parent/Guardian Names:_________________________________

Address:______________________________________________

City,zip:_______________________________________________

Home Phone:_________________ Cell Phone:________________

E-Mail Address:_________________________________________

Emergency Contact Name:________________________________

Phone:________________ Relationship:_____________________

Yrs of Dance Experience: Ballet_____ Jazz_____ Modern______

Tap_______Hip Hop________

Class times:

Seniors Ages 14 - 18 10:00 am - 4:30 pm

Juniors Ages 11 - 14 12:00 pm - 6:30 pm

T-Shirt Size: Child S Child M Child L Adult S Adult M Adult L

Please mail completed registration form and a check payable to Teen Dance Company.

Intensive Cost $600: Register before July 10 and save $50 (Cost $550).