APPLICATION

DANCE WITHOUT WALLS
APPLICATION
Student Name

First NameLast Name
Birth Date

MonthDayYear
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you Enrolling more than one child from your household?

YesNo
If so, Names of siblings/other children you are enrolling
Home Phone

Area CodePhone Number
Cell Phone of Parent or Guardian

Area CodePhone Number
Work

Area CodePhone Number
Student Cell Phone

Area CodePhone Number
Gender

MaleFemale
Parent/Guardian Information
Full Name

First NameLast Name
Relationship to Participant:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is this the person who will pick up your child at the end of each day?

YesNo
If Not, Please list who:
Emergency Contact Information
The first attempt will be made to contact the dancer’s parents/guardians.

Emergency Contacts listed below must be able to pick your child up in the event of an emergency.
Full Name

First NameLast Name
Relationship to Participant:
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Because Dance Without Walls is a non-auditioning summer intensive, we require all applicants to answer the following questions that will help us to determine the serious nature of your inquires and needs.
1.Please name one reason why you have chosen dance to express yourself and how would the world benefit from your dancing?
2. What dance styles are your favorite and why?
3. If there was no such thing as dance, how do you think the world would be affected?
Should be Empty:

APPLICATION

Parent/Guardian Information

Emergency Contact Information