Summer Intensive Application - Contemporary West Dance Theatre

Summer Intensive Application Form

Application Deadline is Friday, May 10, 2024

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)

Continuing the Legacy Dance Foundation

Summer Intensive Application Form

Personal Information

Emergency Contact

Additional Information

Credit Card Authorization

About

Updates

Support

Follow Us

Stay in Touch