OFFICIAL COMPETITION ENTRY FORM

rd
3 Ormoc National Open DanceSport Championship
June 16, 2019 Ormoc City Superdome
REQUIREMENTS
Completely filled-out Entry Form 2 pcs. 2x2 pictures each
Photocopy of birth certificate( for participants under 18 y/o) Complete entry fee
COMPETITORS'INFORMATION
REGIONREPRESENTED COACH
MALEPARTNER DateofBirth(MM/DD/YYYY)
LastName FirstName Middle Initial
2pcs.2x 2picture
Address

MobileNo. Landline Email

School(ifapplicable)

FEMALEPARTNER DateofBirth(MM/DD/YYYY)
LastName FirstName MiddleInitial
2pcs.2x 2picture
Address

MobileNo. Landline Email

School(ifapplicable)
EVENTS(Please check the event/s you wish to enter)
STANDARD LATIN
Beginner Waltz Special Event A (W,T,VW,SF,Q) Beginner Cha ChaCha Special Evrent A (S,C,R,PD,J)
Beginner Tango GradeD (W,T) Beginner Rumba GradeD (C,R)
Beginner Quickstep GradeC (W,T,Q) Beginner Jive GradeC (C,R,J)
JuvenileC (W,T,Q) GradeB (W,T,SF,Q) JuvenileC (S,C,J) GradeB (S,C,R,J)
Juvenile A (W,T,VW,SF,Q) GradeA(W,T,VW,SF,Q) JuvenileA(S,C,R,PD,J) GradeA(S,C,R,PD,J)
Junior C (W,T,Q) Closed Region 8 (W,T,Q) Junior C (C,R,J) Closed Region 8 (C,R,J)
Junior A(W,T,VW,SF,Q) Junior A(S,C,R,PD,J) Third Kind (C,R,J)
YouthC (W,T,Q) YouthC (C,R,J)
YouthA(W,T,VW,SF,Q) YouthA(S,C,R,PD,J)
Special Event C (W,T,SF) Senior C (C,R,J)

SpecialEvent 2:Guest-Guest orGuest-DI Senior: Both must be born1983 or before

Guest must be at least 40 yrs.old. / DI at least 18 yrs. old. Youth: Both born2000-2002
Graded Events: Born1998 or before Junior: Both born2003-2006
Beginner: must be 18 and above Juvenile: Both born2007 or later; prescribed syllabus routine only
CERTIFICATION AND WAIVER
We here by certify that all information entered above are correct and accurate, and shall be the basis for qualification and approval of our participation in the registered event(s).Furthermore, we
understand that falsification of any personal information can disqualify us from the competition. We shall abide by the rules of 3rd Ormoc National Open DanceSport Championship in their final
decision and hereby absolve them of any obligation for any injuries, damages, or losses we may sustain in the course of preparation and execution of this competition.

MALE PARTNER'S SIGNATURE FEMALE PARTNER'S SIGNATURE

PARENT/GUARDIAN'S SIGNATURE ABOVE PRINTED NAME(under18 y/o) PARENT/GUARDIAN'S SIGNATURE ABOVE PRINTED NAME(under18 y/o)
ENTRY FEES: DEADLINE OF SUBMISSION OF DEADLINE OF PAYMENT:
Juvenile/Junior:P1,000 (1stevent)+P300 for each subsequent event** ENTRY FORMS:
Other Events: P1,500 (1stevent) + P500 for every subsequent event* June 10, 2018(MONDAY) 9:00pm June 15, 2018(SATURDAY) 9:00pm

Date submitted: Received by: Signature: Entry Fee(s)due:

FOR DTOC OFFICIAL USE ONLY
REQUIREMENTSCHECK
M F Photocopyof M F LIST AmountPaid: Date paid:
2pcs.2x2photos EntryFee
BirthCertificates
Receivedby: Remarks: Signature:

F: www.facebook.com/byronrojas M:+639397773622 E: circadirector17@gmail.com