Summer Intensive Registration Form

Competitive Summer Intensive
Recommended for students with experience in a Competitive Dance program or similar program.

Ages 7+.

*New Evening Program!*
Tuesday, August 13th; Thursday, August 15th; Tuesday, August 20th; Thursday, August 22nd; Tuesday, August 27th; Thursday, August 29th | 5 - 9pm

$55/evening or $45/evening if registered for all 6! ($60 savings!)

Take classes in multiple styles with special Guest Instructors and your EDC favs. All competitive students should attend! Get back into dance mode before the season begins! :)

If you would prefer to register and pay in person or have any questions, please call us at 204-785-1285.
Dancer's Info:
Last Name *
First Name *
Gender *

Male Female
Birth Date *

Month Day Year
If you are a current Evolution Dance Company student you may leave the fields not marked with a (*) blank. If you are a new student, welcome and please be sure to fill out all information :)
Address
City
Province
Postal Code
Home Phone

- Area Code Phone Number
Emergency Contact Name(if parent or guardian is not avaliable) *
Emergency Number *

- Area Code Phone Number
Parent or Legal Guardian Information:
Parent/Legal Guardian *
Main Phone *

- Area Code Phone Number
Email Confirmation
Parent's Email *
Other Information
Current or most recent Dance Studio *
Health Information
All fileds are required below. If nothing applies, please put "NONE" in the box.
Any physical, mental or other condition that would require special attention or medication while at class? *
Please list any allergies *
Payment Information & Class Selection

$55/evening or $45/evening if signing up for all six!
Dance Intensive 2019 - Select each day attending. If attending all six days, only select the first option. Classes will be held from 5:00 - 9:00pm each evening.

Coupons only valid for first option. (Those attending all 6 days).

Dance Intensive 2019 - Select each day attending or select "All 6!" *

All 6! August 13th, 15th, 20th, 22nd, 27th and 29th. Only $45/evening! $ 270.00 CAD

Tuesday, August 13th $ 55.00 CAD

Thursday, August 15th $ 55.00 CAD

Tuesday, August 20th $ 55.00 CAD

Thursday, August 22nd $ 55.00 CAD

Tuesday, August 27th $ 55.00 CAD

Thursday, August 29th $ 55.00 CAD

Enter coupon

Total $ 0.00 CAD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Waiver
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named dancer, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named dancer by authorized personnel. I authorize Evolution Dance Company, Ltd. to use my dancer's picture and video in any promotional material(web,print,or media).

I recognize that dance is a physically strenuous activity that can lead to injury. I hereby agree to forever release, discharge and acquit Evolution Dance Company Ltd, its legal representative, employees, contractors and all persons acting under its permission or authority from any and all liabilities, claims for damages or injuries of any kind, nature, or description resulting from or related in any way which may arise from participating in classes at Evolution Dance Company Ltd.
Signature *

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Electronic signature, please initial *
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Competitive Summer Intensive

Dancer's Info:

Parent or Legal Guardian Information:

Email Confirmation

Other Information

Health Information

Payment Information & Class Selection

Waiver