2023 Saints Dance Experience Day

Saturday, Nov 11

Beginning 8 a.m. and continuing through Football Game

Cost:

$10 per attendee

For more information contact Kara Thompson at thompsk@thomasmore.edu

Name*

First NameLast Name

Age*

Dance team / Studio*

Parent / Guardian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

We, the undersigned, for ourselves, our heirs and executors, waive, release and forever discharge Thomas More University and the Dance Team, its staff, employees and representatives from all rights and claims for damages, injury or loss to person or property which may occur during participation in dance activities or while at dance experience day.

We certify that the applicant is in good physical health and has permission to participate in the Dance Experience Day and hereby authorize the employees and agents of said team to act according to their best judgement in any situation requiring medical attention. All costs incurred are the responsibility of the parent/guardian. A copy of this authorization shall be considered as valid and effective as the original.

Signature*

Emergency Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Insurance Company*

Policy Number*

Please list any medical conditions the staff should be aware of

Total Due

Invoice

Pay by Credit Card

USDDance Experience Day

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

2023 Saints Dance Experience Day

Saturday, Nov 11

Beginning 8 a.m. and continuing through Football Game

Cost:

$10 per attendeeFor more information contact Kara Thompson at thompsk@thomasmore.edu

$10 per attendee

For more information contact Kara Thompson at thompsk@thomasmore.edu