Select a Workshop *

Fall Break: 3-Day Dance Intensive - ages 6 to Adults (Sept 30-Oct 2) = Select for class options and prices

Fall Break: 5-Day Defying Gravity Workshop - ages 8 to 18 (Oct 6-10) = $175

Name of Participant *

First Name

Last Name

Name of Parent or Legal Guardian (if participant is under 18)

First Name

Last Name

Phone *

(###)

###

####

Emergency Contact # *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

T Shirt Size (for Defying Gravity Workshop participants only)

Child Small

Child Med

Child Large

Child XL

Adult Small

Adult Med

Adult Large

Adult XL

Adult XXL

Is the participant a Senior Citizen? *

Senior Citizens receive a $6 discount!

Yes

No

Do you plan to use ESA funding to pay for this workshop? *

Yes

No