Lyrical Dance Intensive

Participant Application
Application deadline is June 7th, 2014
First Participants Full Name & Age
________________________________________________________________________________________________
Second Participants Full Name & Age
________________________________________________________________________________________________
Third Participants Full Name & Age
________________________________________________________________________________________________
Parent/Legal Guardian Name ________________________________________________________________________
Contact Number: (
) _________________________
Emergency Contact Person/Relationship: _______________________________________________________________
Emergency Contact Number: (
) ___________________________
How many years of dance experience does participant have? (If you are applying for more than one child, please list years
separately.) __________________________________________________________________________________
Which style of dance has the participant studied or would like to study?
Contemporary
Ballet
Lyrical
Liturgical
Tap
Hip-hop
Why do you as a parent/ guardian desire to use dance as an extracurricular activity? _____________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Can the participant participate in activities like morning devotional? YES

NO

How did you hear about the program?

Commercial Appeal
Flyer
Word of Mouth
Other
Dance can be injurious. Does the participant have medical insurance? YES

NO

Applications can be emailed to lyricaldanceintensive@gmail.com.