Spur for a Day Dance Clinic Registration 2025

Student Information

Student's Name*

First NameLast Name

Birth Date*

MonthDayYear

Age (as of 08/23/2025)*

School Attending*

Grade Level*

Gender*

MaleFemale

Student's T-shirt size*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name*

First NameLast Name

Mobile Number*

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Emergency Contact Phone Number*

Medical Info: Hospital Preference, Physician Name

Release Info and Acknowledgement

I agree to release the Silver Spurs team members, Directors and Silver Spurs Booster Club for all legal responsibilities of the above name participant at the dance clinic on 08/23/2025.

I hereby grant permission for a representative of the Silver Spurs to transport my child to the physical and/or medical facility for treatment of an illness or injury. I give permission for my child to be photographed during the clinic or performance. I authorize any attending physician to medically treat my child as deemed appropriate.

Please type your name in box below and sign in signature box*

Signature of Parent or Guardian*

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

My Products

Dance Clinic: 9:00 am - 12:00 pm

$35.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay