Summer Intensive Application - Contemporary West Dance Theatre

Summer Intensive Application Form

Personal Information

Name(Required)

First Last

Date of Birth(Required)

Email(Required)

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Emergency Contact

Name(Required)

Relationship(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Additional Information

MEDICAL/ALLERGIES, etc.: Do you have any injuries or allergies that we need to know about? Please explain in detail.(Required)

Training(Required)

Credit Card Authorization

Registration Fee(Required)

Price:

Credit Card Authorization(Required)

Price:

Total

I Authorize Contemporary West Dance Theatre/ Continuing the Legacy Dance Foundation, to charge my credit card for the following amount listed above. I acknowledge the charges and agree to honor and abide by the terms of payment I agree that the fee charged is Non-Refundable once service starts.

Credit Card(Required)

Cardholder Name

Card Details

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Summer Intensive Application Form

Personal Information

Emergency Contact

Additional Information

Credit Card Authorization

The Company

Updates

Support

Follow Us

Stay in Touch