KIDS DANCE FREE Summer Dance Convention Registration Form
Hosted by KEDA Co Performing Arts
Location: Bethune-Cookman Performing Arts Center
Convention Dates: Saturdays — July 11, July 18, & July 25 9:00am-12:00pm
Student Information
Student Full Name:
Date of Birth:
-
Month
-
Day
Year
Date
Age:
School:
Grade:
Parent/Guardian Name:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Home Address:
Emergency Contact Information
Emergency Contact Name:
Relationship to Student:
Emergency Phone Number:
Format: (000) 000-0000.
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Dance Experience
Please check all styles the student has experience in:
Please check all styles the student has experience in:
Ballet
Jazz
Hip Hop
Contemporary
Tap
Acro
Musical Theater
Beginner / No Experience
Years of Dance Experience:
Convention Attendance
Please select the dates your child will attend:
Please select the dates your child will attend:
Saturday, July 11
Saturday, July 18
Saturday, July 25
Medical Information
Please list any allergies, injuries, medical conditions, or special accommodations:
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Parent/Guardian Waiver & Consent
I understand that participation in dance and physical activity involves some risk of injury. I hereby release KEDA Co Performing Arts, Bethune-Cookman Performing Arts Center, instructors, staff, and volunteers from liability for injuries or accidents that may occur during participation.
I authorize emergency medical treatment if necessary.
I also give permission for photographs and video recordings taken during the event to be used for promotional and educational purposes.
Parent/Guardian Signature:
Date:
-
Month
-
Day
Year
Date
Event Information
KIDS DANCE FREE Summer Convention provides free dance classes, movement education, performance workshops, and enrichment opportunities for youth dancers in a fun and supportive environment.
Participants should arrive in comfortable dance attire with water and appropriate dance shoes or sneakers.
For additional information, please contact:
KEDA Co Performing Arts
Email: kedacoperformingarts@gmail.com
Phone: 386-882-KEDA
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